Transdermal hormone replacement therapy (HRT) does not reduce the risk of cardiac events in postmenopausal women with existing coronary artery disease (CAD). In the PHASE trial (Papworth HRT Atherosclerosis Study), researchers randomized 255 postmenopausal women with angiographically proven coronary artery disease to receive either transdermal HRT--17-beta-estradiol with or without cyclic norethisterone--or no hormone replacement therapy. The women were followed for 4 years. Overall, 134 women received hormone replacement therapy. Of these, 58 had had a previous hysterectomy. The other 121 women served as controls.

On intention-to-treat analysis, there was no statistical difference in the incidence of unstable angina requiring hospitalization, MI or premature death from heart disease in women receiving HRT and women not receiving the therapy. Respectively, the average event rates were 15.6 and 12.6 per 100 patient-years. Results from the PHASE study also seem to indicate an increased risk of thromboembolic complications, such as stroke, with HRT. This observation is supported by results from the HERS study, a randomized trial carried out in the US that included 3000 women, and was designed to assess the cardioprotective effect of combined HRT in women with documented CAD.

It may therefore be appropriate that women with proven coronary artery disease should not commence HRT. Nevertheless, women receiving HRT for more than 2 years should continue.
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