Hormone therapy with estrogen plus progestin, or estrogen alone, should not be given as new drugs for secondary prevention of coronary events to post- menopausal women after NSTE-ACS and should Amsterdam et al 2014 AHA/ACC NSTE-ACS Guideline e381 not be continued in previous users unless the ben- efits outweigh the estimated risks.17,470 472 (Level of Evidence: A) Although prior observational data suggested a protective effect of hormone therapy for coronary events, a randomized trial of hormone therapy for secondary prevention of death and MI (the HERS [Heart and Estrogen/Progestin Replacement] study) failed to demonstrate a beneficial effect.473 There was an excess risk for death and MI early after initiation of hor- mone therapy. The Women s Health Initiative included random- ized primary prevention trials of estrogen plus progestin and Both trials were stopped early owing to an increased risk related to hormone therapy that was believed to outweigh the potential benefits of further study.470 472 It is rec- ommended that post-menopausal women receiving hormone therapy at the time of a cardiovascular event discontinue its use and that hormone therapy should not be initiated for the primary or secondary prevention of coronary events. However, there may be other permissible indications for hormone therapy in postmenopausal women (eg, treatment of perimenopausal symptoms such as flushing or prevention of osteoporosis) if the benefits are believed to outweigh the increased cardiovascular risk. Postmenopausal women who are >1 to 2 years past the ini- tiation of hormone therapy who wish to continue such therapy for another compelling indication should weigh the risks and benefits, recognizing the greater risk of cardiovascular events and breast cancer (combination therapy) or stroke (estrogen).473 6.3.6. Antioxidant Vitamins and Folic Acid: Recommendations Class III: No Benefit 1. 