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Circulation: Arrhythmia and Electrophysiology

Clinical Articles, News & Views

Hormone replacement therapy linked to atrial fibrillation

The risk of atrial fibrillation (AF) is modestly elevated in women taking postmenopausal hormone-replacement therapy (HRT), according to a new analysis1 of the Women’s Health Initiative (WHI) trials published recently in Circulation: Arrhythmia and Electrophysiology.

The research is based on a recent linkage of WHI results and Medicare data. Incident AF was identified using electrocardiogram and diagnosis codes from Medicare or hospitalisation records, and hazard ratios (HRs) were estimated using Cox proportional-hazards regression.

After excluding participants with baseline AF, researchers found 611 incident cases over a mean 5.6 years among 16,128 WHI participants taking oestrogen plus progesterone and 683 cases over a mean 7.1 years among 10 251 taking oestrogen alone.

Incident AF was more frequent in the active, as compared with the placebo, groups of both trials, reaching significance in the trial of oestrogen alone in women with prior hysterectomy (HR 1.12; p=0.05) and in the pooled analysis (HR 1.12; p=0.05), but not in the oestrogen-plus-progestin trial (HR 1.07; p=0.44).

These results were only minimally affected by adjustment for incident stroke, coronary artery disease, and heart failure, “suggesting that the HRT effect on incident AF may be, at least in part, mediated through an increase in incident cardiovascular disease caused by HRT use,” the authors conclude.


1. Perez MV, Wang PJ, Larson JC, et al. Effects of postmenopausal hormone therapy on incident atrial fibrillation: the Women’s Health Initiative randomized controlled trials. Circ Arrhythm Electrophysiol 2012.

Published on: December 20, 2012

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