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After randomized trials failed to support the use of hormone replacement therapy (HRT) for preventing cardiovascular disease (CVD), HRT use for postmenopausal women declined. Our analysis of 1999-2000 and 2003-2004 National Health and Nutrition Surveys (NHANES) shows that HRT use decreased 19% (from 27.6 to 8.4%; P<.001) among women with CVD versus 3% (from 19.8 to 16.8%; P=.68) among low-risk women, suggesting that most of the drop in HRT use may be among women prescribed HRT as an unproven treatment to prevent CVD.