Recommendation grades [A, B, C, D, E, I] and levels of evidence [I, II-1, II-2, II-3, III] are indicated after the recommendation. Definitions for these grades and levels of evidence are repeated following the recommendation.

Hormone replacement therapy for the primary prevention of cardiac disease and cardiac mortality in perimenopausal women. There is fair evidence to recommend against the use of hormone replacement therapy (HRT) for the primary prevention of myocardial infarction and death from cardiovascular disease in perimenopausal women without established coronary artery disease (CAD). [D recommendation]

For combined estrogen plus progestin therapy:

• Increased risk of non-fatal myocardial infarction (MI) and coronary death (7 more cases/10,000)
• Increased risk of stroke (8 more cases/10,000), venous thromboembolism (18 more cases/10,000).

Overall increased relative risk of 22% of an adverse outcome for cardiovascular disease.

[Supporting Evidence: Cauley et al., 1997; Falkeborn et al., 1992; Falkeborn et al., 1993; Finucane et al., 1993; Folsom et al., 1995; Lafferty & Fiske, 1994; Schairer et al.,1997; Sourander et al., 1998; Sturgeon et al., 1995; Hernandez Avila, Walker, & Jick, 1990; Bush et al., 1987; Criqui et al., 1988; Grodstein et al., 1996; Henderson, Paganini-Hill, & Ross, 1991; Nachtigall et al., 1979; Wilson, Garrison, & Castelli, 1985; Wolf et al., 1991]

To maintain heart health, women should be advised to adopt other effective preventive strategies, such as lifestyle changes that include increased exercise, lower fat diets, smoking cessation, and blood pressure assessment and control.

There is insufficient evidence to make a recommendation on HRT for the primary prevention of stroke and death from cerebrovascular disease (CVD). Since stroke is a major cause of morbidity and mortality in Canadian women, other beneficial preventive measures, such as aggressive treatment of hypertension, should be used rather than HRT.

Definitions:

Recommendations Grades for Specific Clinical Preventive Actions

A: The Canadian Task Force (CTF) concludes that there is good evidence to recommend the clinical preventive action.

B: The CTF concludes that there is fair evidence to recommend the clinical preventive action.

C: The CTF concludes that the existing evidence is conflicting and does not allow making a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making.

D: The CTF concludes that there is fair evidence to recommend against the clinical preventive action.

E: The CTF concludes that there is good evidence to recommend against the clinical preventive action.

I: The CTF concludes that there is insufficient evidence (in quantity and/or quality) to make a recommendation; however, other factors may influence decision-making.

Levels of Evidence

I Evidence from well-designed randomized controlled trial(s)

II-1 Evidence from well-designed controlled trial(s) without randomization

II-2 Evidence from well-designed cohort or case–control analytic studies, preferably from more than one centre or research group

II-3 Evidence from comparisons between times or places with or without the intervention; dramatic results from uncontrolled studies could be included here

III Opinions of respected authorities, based on clinical experience; descriptive studies or reports of expert committees

None provided

Maneuver: Hormone replacement therapy for the primary prevention of cardiac disease and cardiac mortality in peri-menopausal women.

Level of Evidence

Seven prospective cohort studies with internal controls, or randomized controlled trials (I, II-2)

Twelve additional prospective cohort studies with internal controls, or randomized controlled trials

Not applicable: The guideline was not adapted from another source.

2004 Apr 27

Canadian Task Force on Preventive Health Care - National Government Agency [Non-U.S.]

The Canadian Task Force on Preventive Health Care (CTFPHC) is funded through a partnership between the Provincial and Territorial Ministries of Health and Health Canada.

Canadian Task Force on Preventive Health Care (CTFPHC)

Canadian Task Force on Preventive Health Care (CTFPHC) Members: Dr. John W. Feightner, (Chair) Professor, Department of Family Medicine, The University of Western Ontario, London, Ont.; Dr. Harriet MacMillan, (Vice-Chair) Associate Professor, Departments of Psychiatry and Behavioural Neurosciences and of Pediatrics, Canadian Centre for Studies of Children at Risk, McMaster University, Hamilton, Ont.; Drs. Paul Bessette, Professeur titulaire, Département d'obstétrique-gynécologie, Université de Sherbrooke, Sherbrooke, Que.; R. Wayne Elford, Professor Emeritus, Department of Family Medicine, University of Calgary, Calgary, Alta.; Denice Feig, Assistant Professor, Department of Endocrinology, University of Toronto, Toronto, Ont.; Joanne M. Langley, Associate Professor, Departments of Pediatrics, Dalhousie University, Halifax, NS; Valerie Palda, Assistant Professor, Department of General Internal Medicine, University of Toronto, Toronto, Ont.; Christopher Patterson, Professor, Division of Geriatric Medicine, Department of Medicine, McMaster University, Hamilton, Ont.; Bruce A. Reeder, Professor, Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Sask; Elaine E.L. Wang, Vice President, Clinical & Medical Affairs, Aventis Pasteur, Toronto, Ont.

Resource People: Nadine Wathen, Coordinator; Ruth Walton, Research Associate; and Jana Fear, Research Assistant, Canadian Task Force on Preventive Health Care, Department of Family Medicine, The University of Western Ontario, London, Ont.

Competing interests: none declared

None available

This NGC summary was completed by ECRI on August 13, 2004. The information was verified by the guideline developer on September 15, 2004.