The article in the ARCHIVES by Weintraub and colleagues1 contends that fluctuations in the levels of lipids should be taken into account when monitoring postmenopausal women receiving combined sequential estrogen replacement therapy (ERT) for hypercholesterolemia. They justify the importance of such monitoring with the statement that "ERT is associated with a 50% reduction in the incidence of coronary artery disease(CAD)."1 While this statement might have been well founded at the time of submission of the paper, new scientific evidence has surfaced since then that sheds a different light on the role of estrogen in the treatment of ischemic heart disease. The Heart and Estrogen/ Progestin Replacement Study (HERS) trial recently published in JAMA2 has shown under randomized placebo controlled double-blind conditions that ERT did not decrease the incidence of coronary heart disease events (nonfatal myocardial infarction or coronary heart disease death) in a large number of postmenopausal women followed for an average of 4.1 years. In fact, there was increased mortality associated with ERT in the first year of the trial, later compensated by a decreased death rate in years 4 and 5. The authors of the HERS trial state that the "lack of an overall effect occurred despite a net 11% lower low-density lipoprotein cholesterol level and 10% higher high-density lipoprotein cholesterol level in the hormone group compared with the placebo group."2 Therefore, at the moment the usefulness of estrogen/progestin in the management of coronary artery disease is being seriously questioned.
Ness J, Pan CX. Lipid Levels and Estrogen Replacement Therapy in Postmenopausal Women. Arch Intern Med. 1999;159(9):1013. doi: