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March 3, 1999

Hormone Replacement Therapy for Secondary Prevention of Coronary Heart Disease

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(9):794-797. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-9-jbk0303

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.

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