In the first year after hormone discontinuation, the risk for cardiac death was significantly higher in the discontinuers than in an age-standardized background population. However, beyond 1 year, the risk was lower.
Similarly, the risk for stroke death in the first year was higher in the discontinuers in than in an age-standardized background population.
A Paradigm Shift
In addition, cardiac mortality was higher during the first year in discontinuers than in those who continued on hormone therapy (standardized mortality ratio [SMR], 2.30; 95% confidence interval [CI], 2.12 - 2.50), as was stroke mortality (SMR, 2.52; 95% CI, 2.28 - 2.77).
"In my view, we have to shift the whole attitude, first in gynecologists and general practitioners, and eventually in cardiologists," Dr Mikkola said.
"These are irrefutably consistent data that say that hormones lower mortality — and the message is, you stop, you die," said Howard Hodis, MD, from the atherosclerosis research unit at the University of Southern California at Los Angeles, who was not involved with the study.
"This is another piece, another step forward, that's going to change how we look at things," he told Medscape Medical News. "I think cardiologists will be shocked, and it will be totally resisted."