Date of Graduation

8-14-2010

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

First Advisor

James Ferguson PA-C, MPH

Second Advisor

Annjanette Sommers MS, PAC

Third Advisor

Rob Rosenow PharmD, OD

Abstract

Background: Coronary heart disease (CHD) is a major cause of morbidity and mortality in post menopausal women. There is strong evidence suggesting that estrogen deficiency increases cardiovascular risk. For years hormone replacement therapy (HRT) was thought to be beneficial for the prevention of CHD in postmenopausal women. Observational studies consistently concluded that HRT reduced overall mortality from CHD events in postmenopausal women. A large randomized control trial, called the Women’s Health Initiative (WHI), was later conducted and did not concur with these findings. This created much controversy within the medical community with regard to benefits and risks associated with HRT. However, further analysis of the WHI did show that there was reduced overall mortality in women using HRT aged 50-59. The literature review conducted was to examine if there was in fact a benefit of HRT versus placebo for postmenopausal women to reduce mortality caused from CHD.

Methods: Exhaustive search of available medical literature using Medline-Ovid, CINAHL, and JAMA was conducted with the following terms: hormone replacement therapy, postmenopause, cardiovascular disease, and mortality.

Results: A total of 4 studies were appraised. One study was a randomized control trial and the remaining three studies were observational studies. The randomized control study initially showed an increased mortality rate from CHD among menopausal women using HRT versus placebo users, but after further evaluation did show a decreased mortality rate amongst women aged 50-59 using HRT. Observational studies showed an overall decreased mortality among women using HRT versus non-HRT users caused by CHD.

Conclusion: HRT was initially thought to carry an added benefit of decreasing CHD events in postmenopausal women, but was found in randomized control trials to carry an increased risk for older women. Based on the studies evaluated, it can be concluded that women who are symptomatic from menopause and do not have a history of coronary heart disease or breast cancer would benefit from HRT as soon as menopause starts and experience reduced mortality from CHD events if taken for 2-3 years or possibly more.

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