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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: Dr Petitti1 does not do complete justice to the recent history of epidemiology when discussing the HERS results2 as a triumph of experimentation over observation. Over the past decade, several researchers have consistently presented evidence that the findings of several observational studies on the beneficial effect of HRT on cardiovascular disease were too optimistic.3,4 Of course, there were others who at every opportunity—especially sponsored symposia—presented the case for HRT as "almost proven" and ignored or downplayed the contrary evidence. This created the overall impression of universal support for a preventive effect. As such, the story of hormone supplementation and cardiovascular disease is not fundamentally different from that of passive smoking or calcium channel blockers, wherein the messages of the published studies depended on the authors' source of funding.5 It is not observational epidemiology that is proven wrong by HERS but a one-sided representation of the epidemiologic literature.

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