Published: Jan 28, 2014
By Kristina Fiore, Staff Writer, MedPage Today
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Action Points
- Use of postmenopausal hormone replacement therapy was associated with increased risk of acute pancreatitis, researchers found.
- The risk did not differ by current or past use, but it seemed to be higher among women who used systemic therapy and among those with longer duration of therapy.
Hormone replacement therapy may have a connection to pancreatitis, according to epidemiological data from Swedish researchers.
In a prospective study of about 31,500 postmenopausal Swedish women, those who used HRT had a 57% increased risk of pancreatitis compared with those who didn’t use hormones, Viktor Oskarsson, PhD, of the Karolinska Institute in Stockholm, and colleagues reported online in CMAJ.
The absolute number of cases, however, was small — with 71 cases per 100,000 person-years for women who’d used HRT and 52 cases for those who hadn’t.
Still, Oskarsson and colleagues wrote that clinicians “should consider this potential increase in risk when prescribing this type of therapy.”
Some case reports have suggested that HRT could be tied to pancreatitis, but there were few epidemiologic investigations into the association. So the researchers looked at prospective data from the Swedish Mammography Cohort, which assessed HRT use via a baseline questionnaire in 1997, and linked to data from the Swedish National Patient Register to determine hospitalizations for acute pancreatitis through 2010.
The 57% increased risk of pancreatitis with HRT use wasn’t changed in analyses that controlled for body mass index (BMI) and alcohol intake (RR 1.53, 95% CI 1.17 to 2.01).
Nor were the results altered after controlling for age at menarche, parity, oral contraceptive use, and history of diabetes (RR 1.58, 95% CI 1.21 to 2.08).
Risk did appear to be higher, however, among those who used systemic therapy (RR 1.92, 95% CI 1.38 to 2.66) and among those who’d been on HRT for more than 10 years (RR 1.87, 95% CI 1.11 to 3.17), the researchers reported.
HRT is known to increase the risk of gallbladder disease, so the risk of pancreatitis could be mediated by gallstones. But the researchers said the link between HRT and pancreatitis remained after controlling for cholelithiasis, suggesting that other effects may explain the findings.
The relationship could have something to do with the way HRT can elevate triglycerides, which even at moderately increased levels have been associated with an increased risk of acute pancreatitis, the researchers said.
Exogenous estrogen may also have direct deleterious effects on the pancreas, they added.
The researchers reported no conflicts of interest.
Source reference: Oskarsson V, et al “Postmenopausal hormone replacement and risk of acute pancreatitis: a prospective cohort study” CMAJ 2014; DOI: 10.1503/cmaj.131064.