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August 11, 2004

Effects of Estrogen-Only Treatment in Postmenopausal Women

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2004;292(6):683. doi:10.1001/jama.292.6.686-a

To the Editor: In their editorial about the WHI study, Drs Hulley and Grady1 stated that "Given the absence of evidence in all 3 trials [HERS and both segments of WHI] that these hormone regimens prevent CHD in these populations..., it is now clear that the previously available evidence was misleading." I am puzzled at this conclusion, as the HERS trial was not a preventive study; participants had to meet strict criteria for coronary vascular disease. Thus, that trial only showed that hormone therapy is not an effective treatment for CHD. Similarly, it is not clear how many participants in the WHI were free of disease. Since CHD is a chronic process and takes years to develop, it is very likely that many of the 66% of women in the estrogen and progestin segment of WHI aged 60 years or older had significant disease but were asymptomatic.2