Hormone Replacement Therapy and Mortality for Ischaemic Heart Disease, Cerebrovascular Diseases and Breast Cancer in Italy and the U.S.A.

Journal of Clinical and Basic Cardiology 2002; 5 (1): 105-108

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Keywords: Brustkrebs,  Hormonersatztherapie,  ischämische Herzerkrankung,  Italien,  Mortalität,  USA,  zerebrovaskuläre Erkrankung,  breast cancer,  cerebrovascular disease,  hormone replacement therapy,  ischaemic heart disease,  Italy,  mortality,  USA

Observational studies indicate that hormone replacement therapy (HRT) reduces ischaemic heart disease (IHD) mortality, but not stroke mortality; on the other hand a slight increase in breast cancer (BC) after 5 years of HRT treatment is widely recognised. Prescription of HRT in countries with a generally low IHD incidence rate may thus lead to a different risk/benefit balance for long-term HRT users. In this study we considered female mortality due to IHD, cerebrovascular diseases (CeVD), all malignant neoplasms (MN) and BC in Italy and in the U.S.A. to detect any possible differences that could alter the HRT risk/benefit assessment. In 1997, in Italy as well as in the U.S.A., cardiovascular diseases were the leading cause of death in women aged 50 or over, but with some differences in IHD and CeVD mortality in particular. In Italy, in women aged 50 and over, 12.6 % of all female deaths were attributed to IHD and 14.6 % to CeVD, whereas in the U.S.A. 19.4 % were due to IHD and 8.1 % to CeVD. In the U.S.A., IHD mortality remained constantly higher than CeVD mortality throughout all age decades whereas in Italy this was only the case in the 50-79 age group. The proportion of deaths due to IHD was always higher in the U.S.A. than in Italy. On the other hand, BC mortality is quite similar in the two countries: 3.6 % and 3.0 % of all deaths in women aged 50 or over, in Italy and in the U.S.A, respectively. IHD mortality is higher than BC mortality among American women, and their ratio by age decades is almost twice as high as the one observed in Italy for each decade. In the U.S.A., among women aged 40-49, 50-59, 60-69, 70-79 and 80 or more years, the IHD/BC ratios were 0.5, 1.0, 2.5, 5.2 and 14.6 respectively vs 0.2, 0.3, 1.0, 3.0 and 8.5 in Italy. In the light of these mortality differences, if ongoing randomised clinical trials confirm the use of HRT as primary, or secondary prevention in heart disease, it will still be important to take into account a different risk/benefit ratio for long-term HRT users in countries with an IHD incidence lower than that registered in the U.S.A.