Compared with UCG women, women in the EIG were more likely to improve their health behaviors. The CVD risk profile, as measured by the 10-year CHD risk, improved in women with the highest baseline risk.

Psychosocial characteristics may be associated with an increased risk of coronary heart disease (CHD). Whether hostility predicts recurrent coronary events is unknown. A total of 792 women in the Heart and Estrogen/progestin Replacement Study (HERS) were evaluated prospectively to determine the role of hostility as a risk factor for secondary CHD events (nonfatal myocardial infarction and CHD death). The mean age of study participants was 67 years, and the average length of follow-up was 4.1 years. The study was conducted between 1993 and 1998, and all study sites were in the United States. High Cook-Medley hostility scores were associated with greater body mass index (p = 0.01) and higher levels of serum triglycerides (p = 0.05), and they were inversely associated with high density lipoprotein cholesterol (p = 0.04), self-rated general health (p < 0.001), age (p = 0.05), and education (p = 0.001). Compared with women in the lowest hostility score quartile, women in the highest quartile were twice as likely to have had a myocardial infarction (relative hazard = 2.03, 95% confidence interval: 1.02, 4.01). The relation between hostility and CHD events was not mediated or confounded by the biologic, behavioral, and social risk factors studied. In this study, hostility was found to be an independent risk factor for recurrent CHD events in postmenopausal women.

Objective-The Heart and Estrogen/Progestin Replacement Study (HERS) found no overall effect of estrogen plus progestin (compared with placebo) on coronary event rates in 2763 postmenopausal women with established coronary disease (mean 4.1 years of follow-up). In addition to the events trial, a carotid ultrasound substudy was established in 1993 to be conducted concurrently to determine whether hormone therapy affects the progression of the underlying atherosclerotic process. Methods and Results-Within the larger HERS, a subset of 362 participants underwent carotid B-mode ultrasound examinations at baseline and the end of follow-up. Progression of carotid atherosclerosis was measured as the temporal change in intimal-medial thickness (IMT). Conclusions-IMT progressed in the hormone treatment and placebo groups, although there was no statistical difference between the rates: IMT progressed 26 m/y (95% CI 18 to 34 m/y) in the hormone group and 31 m/y (95% CI 21 to 40 m/y) in the placebo group (Pϭ0.44). There were also no significant treatment effects when the results were examined by carotid segment or were adjusted for covariates. These data support the American Heart Association recommendation that women with established coronary disease should not initiate hormone therapy with an expectation of atherosclerotic benefit. Key Words: women Ⅲ secondary prevention Ⅲ hormone therapy Ⅲ carotid artery disease Ⅲ atherosclerosis N umerous observational studies have documented that compared with nonusers, users of postmenopausal hormone replacement have lower rates of coronary events 1-3 and less extensive coronary and carotid atherosclerosis. 4 -7 Estrogen therapy can decrease LDL cholesterol (LDL-C), increase HDL cholesterol (HDL-C), improve endothelial function, and favorably affect other factors thought to play a role in the pathogenesis of atherosclerosis. 8 -11 Estrogen also inhibits the development of atherosclerosis in animal models. 12,13 Despite the abundance of data from observational studies suggesting that estrogen should be beneficial for the prevention of coronary heart disease (CHD), the Heart and Estrogen/ Progestin Replacement Study (HERS), the first large randomized trial examining secondary prevention with hormones in women, found no effect of estrogen plus progestin (EϩP) on the rate of CHD events in women with established coronary disease over an average treatment period of 4.1 years. 14,15 It was originally noted that within the overall null effect, there were more coronary events in the hormone-treated group in the first year of follow-up and fewer coronary events in years 3 through 5. In an extended posttrial observational follow-up, however, there was no evidence of differences in CHD outcomes between the 2 treatment groups. 16 To examine the effects of estrogen plus medroxyprogesterone acetate on the progression of atherosclerotic disease, a prespecified substudy was established in 1993 in which a subset of HERS participants underwent carotid B-mode ultrasound examinations at baseline and at th...