Kenneth M. Kessler, MD
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Kessler K.; Postmenopausal Hormone Therapy and Cardiovascular Disease. Ann Intern Med. 2001;135:1092-1093. doi: 10.7326/0003-4819-135-12-200112180-00023
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Published: Ann Intern Med. 2001;135(12):1092-1093.
TO THE EDITOR:
The concept of net treatment benefit (1) may add to the conclusions reached by Grodstein and colleagues regarding the effects of hormone replacement therapy on cardiovascular and stroke risk (2). Net treatment benefit is defined as the absolute risk reduction, which is the relative risk reduction multiplied by the outcome prevalence, minus treatment harm. The annual outcome prevalences for “major coronary heart disease” and “stroke” in the reference group are 0.194% and 0.093%, respectively. Since stroke and cardiac events have similar mortality rates in this cohort and both are known to have a similar range of disabilities, it is reasonable to consider that both are of a similar metric (a requisite for applying the concept of net treatment benefit). Modifications of stroke rate by hormone treatment add to treatment benefit in the 0.3-mg group but subtract from benefit (that is, represent treatment harm) in the other two groups. The net treatment benefits for the 0.3-mg, 0.625-mg, and at least 1.125-mg groups are 0.12%, 0.06%, and −0.00008%, respectively. The relative risks with respect to net treatment benefit, which effectively combines cardiac and stroke end points, are 0.57, 0.80, and 1.00, respectively. The 0.3-mg dose seems not only “similar to” but actually superior to the other two doses. There is a small but clearly positive benefit at the 0.625-mg dosing level. The “modestly” increased risk for stroke at the higher dose levels is sufficient to nullify treatment benefit in patients receiving a dose of 1.125 mg or greater. Thus, net treatment benefit effectively separates and more clearly defines the outcomes in the three dosing groups.
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