The Raloxifene Use for The Heart (RUTH) trial results were published in 2004 [1]. This was a randomized, double-blind, placebo-controlled study which recruited 10 101 women above the age of 55 years (mean age 67.5 years), with established coronary artery disease (CAD) or at high risk for CAD. Women were followed for a median period of 5.6 years. The study was completed by about 80% of the participants, 70% of whom took at least 70% of their assigned medications. The original publication concluded that raloxifene had no effect on the risk for coronary events. But now, a new article brings post-hoc analyses and more details on RUTH subgroups with a focus on the age factor [2]. In women < 60 years old at baseline, a significant reduction in risk for CAD events was demonstrated (hazard ratio = 0.59; 95% confidence interval (CI) 0.41–0.83), but such an effect was not recorded in older women. Another intriguing finding unrelated to age was that women with the highest risk score for CAD (> 9 risk points) were those who benefited most, with a 27% reduction in hazard ratio, which almost reached a statistical significance (95% CI 0.68–1.01).
Author(s)
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Amos Pines
Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel
Citations
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Barrett-Connor E, Mosca L, Collins P, et al. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med 2006;355:12537.
http://www.ncbi.nlm.nih.gov/pubmed/16837676 -
Barrett-Connor E, Grady D, Sashegyi A, et al. Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial. JAMA 2002;287:84757.
http://www.ncbi.nlm.nih.gov/pubmed/11851576 -
Collins P, Mosca L, Geiger MJ, et al. Effects of the selective estrogen receptor modulator raloxifene on coronary outcomes in the Raloxifene Use for the Heart Trial. Results of subgroup analyses by age and other factors. Circulation 2009;119:92230. Published February 24, 2009.
http://www.ncbi.nlm.nih.gov/pubmed/19204301 -
Anderson GL, Limacher M, Assaf AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Womens Health Initiative randomized controlled trial. JAMA 2004;291:170112.
http://www.ncbi.nlm.nih.gov/pubmed/15082697 -
Mendelsohn ME, Karas RH. Molecular and cellular basis of cardiovascular gender differences. Science 2005;308:15837.
http://www.ncbi.nlm.nih.gov/pubmed/15947175 -
Leung FP, Tsang SY, Wong CM, et al. Raloxifene, tamoxifen and vascular tone. Clin Exp Pharmacol Physiol 2007;34:80913.
http://www.ncbi.nlm.nih.gov/pubmed/17600563
