Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor
To the Editor: The belief that HRT
protects against heart disease is rooted not only in observational
studies,1 but also in a conviction that female hormones are
the protective factor in menstruating women. Many physicians embraced
the conclusions of the observational studies because these studies
seemed to confirm the "fact" of hormonal protection in young women.
The notion that estrogen protects has achieved the status of a largely
unquestioned myth despite serious unresolved issues2 and
the absence of definitive trial data addressing this important
question. If hormonal influences explain the virtual absence of MI in
menstruating women, some discernible impact of HRT would be expected.
The HERS study3 shows no cardiovascular benefit of HRT in
older women with heart disease. The study is thus relevant to the
mystery of the sex difference in heart disease rates.
Sullivan JL. Hormone Replacement Therapy for Secondary Prevention of Coronary Heart Disease. JAMA. 1999;281(9):794-797. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-9-jbk0303