Raloxifene and Cardiovascular Events in Osteoporotic Postmenopausal Women

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Abstract
Coronary heart disease (CHD) is the leading cause of death among postmenopausal women in the United States and most of the Western world.1 In observational studies, postmenopausal women who take hormone replacement therapy (HRT), alone or with a progestin, have approximately 30% less risk of CHD compared with untreated postmenopausal women.2 Randomized clinical trials have not confirmed a beneficial effect of HRT on either the progression of coronary atherosclerosis or the risk of cardiovascular (CV) events in postmenopausal women with existing CHD.3,4 In the Heart and Estrogen/progestin Replacement Study (HERS),3 and in preliminary information from the Women's Health Initiative (WHI),5,6 women assigned to receive HRT experienced an early increased risk of acute coronary events. In the Women's Estrogen for Stroke Trial (WEST),7 women assigned to estradiol had an increased risk of stroke compared with placebo during the first 6 months of treatment. Pooled analyses of smaller, short-term trials8,9 and recent reports from observational studies10-12 also suggest a transient increase in risk of recurrent CV events after initiation of HRT in postmenopausal women.