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August 11, 2004

Effects of Estrogen-Only Treatment in Postmenopausal Women—Reply

Author Affiliations

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

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

In Reply: Dr Brubaker suggests that the failure to find that postmenopausal hormone therapy prevented CVD events in participants from WHI and HERS was due to the presence of prior coronary artery disease in many of the women. The evidence from the clinical trials, however, does not support this belief. Estrogen-plus-progestin caused a greater and more prolonged increase in risk of coronary events in WHI than in HERS, even though overt prior coronary disease was rare in WHI and universal in HERS participants. Subgroup analyses did not reveal benefit among women in WHI who did not have prior CVD1,2 or its risk factors.2 Women in the youngest age group (aged 50-59 years) who were given estrogen alone had a somewhat lower risk of CVD events than those who received placebo,1 but the possible age interaction was not statistically significant nor was there a similar trend in the estrogen-plus-progestin trial.2