Continuation of hormone replacement therapy during acute myocardial infarction after the women's health initiative study. Is it the time for change?

Hormone replacement therapy (HRT) was given for many years in order to relieve menopausal symptoms and was used for as long as symptom control was necessary. The Heart and Estrogen/Progestin Replacement Study (HERS) and Women's Health Initiative (WHI) studies showed that HRT should not be given for primary or secondary prevention of coronary heart disease (CHD). However, what about those patients during acute myocardial infarction who are already taking HRT? Is the ‘don't stop don't start’ rule still true? A 58-year-old white female, on HRT was admitted with acute myocardial infarction (MI). We tried to answer the above questions in light of the new information: 1) continuation of HRT during acute MI 2) HRT and cardiovascular risk factors 3) HRT and coronary revascularization 4) HRT and the prevention of acute MI Based on current evidence available from HERS and WHI trials, it is not advisable to initiate HRT in women with established CHD for the sole purpose of preventing first or recurring coronary events. A statement by the American Heart Association recommends that the decision to continue or stop HRT in women with CV disease should be based on established benefits and risks, taking patients preference into account. The WHI study did not change this policy in the acute phase. In most cases, we believe HRT should be continued for some period (our decision for 3 months long was arbitrary), and discontinued gradually. We believe that this should be the policy until we have a double-blind placebo-control data to revise.