On behalf of the American Society for Reproductive Medicine, Birmingham, Ala, the Menopause Special Interest Group, Birmingham, would like to comment on the recent review article by John A. Blakely,1 who reassessed the findings of the Heart and Estrogen/Progestin Replacement Study (HERS).2 The HERS study was conducted to determine if hormone replacement therapy (HRT) reduces the number of coronary events in women who already have coronary artery disease (ie, a secondary prevention trial). The results included the unexpected finding that an early increase in coronary events is associated with daily treatment with both 0.625 mg of conjugated equine estrogen and 2.5 mg of medroxyprogesterone acetate at the same time in women with established coronary disease. Over the 4-year period of observation, however, there was no statistical difference between the women receiving estrogen-progestin and those receiving placebo. Dr Blakely suggests that the HRT precipitated this increase in early cardiovascular events. He explains that women in this trial who experienced early cardiovascular events were actually identified, whereas in prior observational studies women having early events were not identified because they were lost to follow-up by the time the information would have been gathered.
Rebar RW, Archer D. Increased Coronary Events, HERS, and HRT: Any Connection?. Arch Intern Med. 2001;161(10):1350. doi: