Post-myocardial infarction hormone therapy revisited

Current guidelines recommend that postmenopausal hormone therapy should not be used in the setting of secondary prevention of coronary heart disease, and that it should be stopped when an acute coronary event occurs. Reviewing the available data on the issue of discontinuation of therapy in post-myocardial infarction patients shows that the basis for this recommendation is not so solid and clear-cut. In fact, the few relevant studies concluded that cessation of hormone therapy carried no benefit, and perhaps even caused some adverse cardiac events, when compared to women who continued with treatment after they suffered a coronary event. The following article uses a recently published study as an opportunity to review this topic. Based on the literature, my personal view is that long-term hormone users should not automatically withhold therapy post-myocardial infarction, but careful individual evaluation and consideration should precede any decision.