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January 1, 2003

Relationship Between Hormone Replacement Therapy, Socioeconomic Status, and Coronary Heart Disease

JAMA. 2003;289(1):44-45. doi:10.1001/jama.289.1.44

To the Editor: In their review of observational studies of postmenopausal hormone replacement therapy (HRT), Dr Nelson and colleagues1 incorrectly claim that our findings from the Nurses' Health Study (NHS)2,3 failed to control for education or socioeconomic status (SES) in analyzing postmenopausal HRT use and risk of coronary heart disease (CHD). Because all NHS participants are registered nurses, with nearly identical education, we adjusted for education using stratification.2,3 The authors also incorrectly state that studies controlling for alcohol intake or physical activity failed to observe a lower risk of CHD among HRT users. We recently reported a relative risk (RR) of CHD of 0.64 (95% confidence interval, 0.54-0.76) for current vs never HRT users, after adjustment for alcohol and physical activity (in addition to other covariates).2

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