Menopausal Hormone Therapy and Risk for Cardiovascular Disease in the WHI Trial
Authors: Sengwee Toh
Journal: Annals of Internal Medicine (2010)

Letters6 July 2010Menopausal Hormone Therapy and Risk for Cardiovascular Disease in the WHI TrialSengwee Toh, ScD, Jacques E. Rossouw, MD, and Miguel A. Hernán, MD, DrPHSengwee Toh, ScDFrom Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA 02215; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Harvard School of Public Health, Boston, MA 02115.Search for more papers by this author, Jacques E. Rossouw, MDFrom Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA 02215; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Harvard School of Public Health, Boston, MA 02115.Search for more papers by this author, and Miguel A. Hernán, MD, DrPHFrom Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA 02215; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Harvard School of Public Health, Boston, MA 02115.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-1-201007060-00022 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We agree with Dr. Harman and colleagues about the importance of both the timing of initiation of postmenopausal hormone therapy and the duration of treatment in relation to CHD, a point we made in our article. Unlike several analyses of observational studies, the WHI estrogen plus progestin trial found no benefit of postmenopausal hormone therapy on either CHD risk or mortality. In contrast, the WHI findings were consistent with observational analyses for stroke, venous thromboembolism, breast cancer (increased risk), hip fractures, and colorectal cancer (decreased risk) (1). Subsequent reanalyses of the observational data (2, 3) suggest that an ...References1. Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002;288:321-33. [PMID: 12117397] CrossrefMedlineGoogle Scholar2. Prentice RL, Langer R, Stefanick ML, Howard BV, Pettinger M, Anderson G, et al; Women's Health Initiative Investigators. Combined postmenopausal hormone therapy and cardiovascular disease: toward resolving the discrepancy between observational studies and the Women's Health Initiative clinical trial. Am J Epidemiol. 2005;162:404-14. [PMID: 16033876] CrossrefMedlineGoogle Scholar3. Hernán MA, Alonso A, Logan R, Grodstein F, Michels KB, Willett WC, et al. Observational studies analyzed like randomized experiments: an application to postmenopausal hormone therapy and coronary heart disease. Epidemiology. 2008;19:766-79. [PMID: 18854702] CrossrefMedlineGoogle Scholar4. Tunstall-Pedoe H. Myth and paradox of coronary risk and the menopause. Lancet. 1998;351:1425-7. [PMID: 9593428] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA 02215; National Heart, Lung, and Blood Institute, Bethesda, MD 20892; and Harvard School of Public Health, Boston, MA 02115.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCoronary Heart Disease in Postmenopausal Recipients of Estrogen Plus Progestin Therapy: Does the Increased Risk Ever Disappear? Sengwee Toh , Sonia Hernández-Díaz , Roger Logan , Jacques E. Rossouw , and Miguel A. Hernán Menopausal Hormone Therapy and Risk for Cardiovascular Disease in the WHI Trial S. Mitchell Harman , Eliot A. Brinton , Frederick Naftolin , George R. Merriam , Marcelle I. Cedars , Ruth G. Freeman , and Nanette Santoro Menopausal Hormone Therapy and Risk for Cardiovascular Disease in the WHI Trial Amos Pines and David Sturdee Menopausal Hormone Therapy and Risk for Cardiovascular Disease in the WHI Trial Jerome L. Sullivan Metrics 6 July 2010Volume 153, Issue 1Page: 61-62KeywordsBreast cancerEstrogensHormonal therapyHormonesMenopauseObservational studiesSex hormonesStrokeVenous thromboembolism ePublished: 6 July 2010 Issue Published: 6 July 2010 CopyrightCopyright © 2010 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...