Stephen J.LurieMD, PhD, Senior Editor
In Reply: Drs Radford and Church and Dr Speizer are concerned that the WHI did not find a benefit for CHD with estrogen plus progestin because the study population in general was too old to benefit and likely had preexisting subclinical disease. It is intriguing to speculate that HRT might prevent the development of plaques in younger women but increase the risk of complications of established atherosclerosis in older women. Data from the WHI trial, however, do not support this hypothesis. First, the risks of HRT were not statistically different in women with vs without prior history of CHD. In addition, the overall hazard ratios for CHD and stroke observed in WHI were somewhat greater than those reported by HERS1 and WEST,2 both secondary prevention trials. Also, as noted in our article, the initial analyses revealed no significant interactions of treatment assignment with age or prior hormone use for any cardiovascular outcome, implying that hormone use soon after menopause (hence, before or at least earlier in the process of atherosclerosis development) conferred a similar increased risk in older women and those who had never used hormones. Subsequent analyses examining the treatment effects by years since menopause, by recency of prior hormone use, and by duration of prior hormone use are under way and may shed further light on these issues.
The WHI Steering Committee and Writing Group. Risks of Postmenopausal Hormone Replacement—Reply. JAMA. 2002;288(22):2823. doi:10.1001/jama.288.22.2823-JLT1211-1-12