At this time, guidelines were revised to recommend against the routine use of HT for reasons other than treatment of menopausal symptoms, and that treatment should continue for the shortest duration possible.( 5, 6) The immediate response was that hormone therapy (HT) was inappropriate for secondary prevention but still retained a role of primary prevention of cardiovascular disease.( 3) In 2002, the Women's Health Initiative (WHI) investigators( 4) reported an increase in the composite outcome, including breast cancer and cardiovascular events, in women without pre-existing cardiovascular disease randomly assigned to receive conjugated equine estrogen and medroxyprogesterone acetate. Prior to the late 1990s, standard practice recommended that women be prescribed hormone therapy (HT, estrogen with or without progestin) for both primary and secondary prevention of cardiovascular disease.( 1) In 1998 the Heart and Estrogen/ Progestin Replacement Study (HERS)( 2) reported an increase in cardiovascular events among women with a history of cardiovascular disease treated with conjugated equine estrogen and medroxyprogesterone acetate.
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