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Estrogen formulations have differing cardiovascular risk profile
Ever since the publication of the Women's Health Initiative randomized trial that demonstrated clinical harm associated with use of conjugated equine estrogens, providers have been left in a challenging position in balancing the risk of these therapies against their benefit in treatment of menopausal symptoms. In the present study, the authors examined cardiac safety of oral conjugated equine estrogen vs. oral estradiol in a population-based case control study of post-menopausal women. Cases of venous thrombosis (n=68), myocardial infarction (n=67) or ischemic stroke (n=48) were matched to 201 post-menopausal women without one of these events. All patients were using oral conjugated equine estrogen or estradiol. After adjustment for risk factors, a greater risk for venous thrombosis was observed in women using oral conjugated equine estrogen as compared with oral estradiol (odds ratio [OR], 2.08; 95% CI 1.02–4.27; P=.045). Use of oral conjugated equine estrogen was associated with an increased risk of myocardial infarction that did not achieve statistical significance (OR 1.87; 95% CI 0.91–3.84; P=.09) and similar risk of ischemic stroke …
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