Clinical Impact of Hormone Replacement Therapy on Atrial Fibrillation in Postmenopausal Women: A Nationwide Cohort Study.

Jaehoon Lee,Hyunji Park,Changsoo Kim,Jongyoun Kim,Sihyun Cho,Yuntae Kim

doi:10.3390/jcm10235497

Jaehoon Lee, Hyunji Park + Show 4 more

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https://doi.org/10.3390/jcm10235497

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Abstract

Individuals with atrial fibrillation (AF), especially women, have an increased risk of stroke and death. Although hormone replacement therapy (HRT) is widely used in postmenopausal women, the association between HRT use and AF risk is unclear. We aimed to investigate the association between various types of HRT and AF. This was a population-based retrospective cohort study from The Korean National Health Insurance Service-National Sample Cohort (2004–2015). Participants were aged 45–60 years and were free from cardiovascular disease and AF at baseline. Overall, 13,452 (64.03%) women had never received HRT, 5671 (26.99%) had received HRT, and 1885 (8.98%) were currently receiving HRT. In multivariable analysis, the relative hazards for AF were significantly higher among current users (p < 0.001) and lower among past users (p = 0.069). Current users—except those using estradiol-only HRT—had significantly elevated AF risk. Among past users, only estradiol plus progestin HRT users had a reduced AF risk after adjusting for covariates (p = 0.027). Ongoing HRT posed an increased risk of AF. The degree of risk varied based on the specific type of estrogen and progestins co-administration. These findings indicate that, with respect to AF risk, oral estradiol-containing HRT is superior to HRT containing oral conjugated equine estrogen or tibolone.

Highlights

Introduction published maps and institutional affilAtrial fibrillation (AF) is the most common sustained arrhythmia and a major public health problem
Among Hormone replacement therapy (HRT) current users, an increased AF risk was observed for all HRT types, except E2 alone
Because the risk estimates were based on only two AF cases in current conjugated equine estrogen (CEE) users, caution must be exercised in result interpretation. In this national cohort study of women without preexisting AF and risk factors for AF, current HRT use was associated with an increased risk of AF, while past HRT use was not

Summary

Introduction

Atrial fibrillation (AF) is the most common sustained arrhythmia and a major public health problem. A higher risk of stroke and stroke-related mortality has been observed in women with AF than in men [2]. The pathophysiological mechanisms behind AF development are complex and not fully understood, there are several reports suggesting that female sex hormones modify AF risk in women [3]. Hormone replacement therapy (HRT) is used to control symptoms of menopause and prevent osteoporosis in menopausal women [4,5]. HRT was once used to prevent cardiovascular disease (CVD) [6,7,8,9]. After the release of Women’s Health Initiative (WHI) study results in the early 2000s, HRT was perceived as a factor that could increase

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