Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
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
Hulley SB, Grady D. Effects of Estrogen-Only Treatment in Postmenopausal Women—Reply. JAMA. 2004;292(6):683. doi:10.1001/jama.292.6.686-b
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