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Postmenopausal Hormone Replacement Therapy and Cardiovascular Mortality in Central-Eastern Europe

^a Departments of Obstetrics/Gynecology, Semmelweis Medical School, Budapest, Hungary
^b Departments of Medicine II, Semmelweis Medical School, Budapest, Hungary
^c Section of Endocrinology, VA Medical Center, Phoenix, Arizona

Zoltan Vajo, VA Medical Center, Section of Endocrinology, 650 E. Indian School Road, 111E, Phoenix, AZ 85012 E-mail: zvajo{at}usa.net.

Decision Editor: William B. Ershler, MD

Background. The leading cause of death among elderly women is cardiovascular (CV) disease in the United States and in Western Europe as well. The protective effect of postmenopausal hormone replacement therapy (HRT) on coronary heart disease has been verified in epidemiologic studies. There are no data available on the rate of HRT use in Eastern Europe. Our goals were to study the rates of HRT in Eastern Europe, to compare them to those of the United States and Western Europe, as well as to compare their CV mortality rates.

Methods. The use of HRT in Eastern Europe was calculated from sales records obtained from all pharmaceutical companies that ship HRT preparations to the given area. Data on HRT in Western countries were taken from the literature. Mortality rates were obtained from the World Health Organization.

Results. The rate (mean ± SD) of HRT in Eastern Europe was 2.88 ± 2.67%, whereas 12.67 ± 9.97% in Western Europe and the United States, p < .05. The cardiovascular mortality rate per 100,000 women older than 45 years in Eastern Europe was higher (1766 ± 158.3) than in the Western countries (1155 ± 164.1, p < .001).

Conclusions. The rate of HRT is markedly lower, whereas CV mortality rates are notably higher in Eastern Europe than in the United States or Western Europe. Because HRT seems to be underutilized in Eastern Europe, to increase its use might be an important tool to improve CV mortality rates. However, due to the risks associated with HRT, other measures to prevent coronary heart disease, such as smoking cessation programs, and other efforts should also be considered in Eastern Europe.