Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
To the Editor: An early increase in coronary
death and nonfatal myocardial infarction (MI) in postmenopausal women with
coronary heart disease (CHD) taking hormone therapy compared with placebo
was an unanticipated adverse outcome in the Heart and Estrogen/progestin Replacement
Study (HERS).1 The time trend for initial
risk and later benefit was statistically significant. Two of us (N.K.W. and
G.L.K.) involved in the HERS study recognized some striking similarities between
the results of this clinical trial in postmenopausal women with those of the
Coronary Drug Project (CDP)2 (with which
all 3 of us were involved), conducted almost 3 decades earlier in men. HERS
and CDP are the only large trials of hormone therapy in populations with CHD,
and both data sets could be analyzed further owing to our personal involvement.
This report compares the primary outcomes of these trials with particular
focus on early excess events following initiation of hormone therapy.
Fontanarosa PB, Wenger NK, Knatterud GL, Canner PL. Early Risks of Hormone Therapy in Patients With Coronary Heart Disease. JAMA. 2000;284(1):41-43. doi:10.1001/jama.284.1.39