Amos Pines, MD; David Sturdee, MBBS, MD, DA
Potential Conflicts of Interest: None disclosed.
Pines A., Sturdee D.; Menopausal Hormone Therapy and Risk for Cardiovascular Disease in the WHI Trial. Ann Intern Med. 2010;153:61. doi: 10.7326/0003-4819-153-1-201007060-00020
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Published: Ann Intern Med. 2010;153(1):61.
TO THE EDITOR:
Since the first article from the WHI in 2002, the validity of the methods of data analysis has been debated. First, debate focused on the use of adjusted or unadjusted hazard ratios, then on the issue of combining the data from the group that received conjugated equine estrogen with medroxyprogesterone acetate and the group that received conjugated equine estrogen alone, or the data from the WHI clinical study and the WHI observational study. Recently, when age became an important variable in the risk–benefit balance of hormone therapy, another debate involved the “timing hypothesis.” Although these arguments are the domain of epidemiologists and statisticians, the lay physicians who practice menopause medicine and prescribe hormones should receive clear messages from the WHI investigators, and patients should be informed and educated to a similar extent. It is therefore of the utmost importance not to send conflicting messages, but the article by Toh and colleagues (1) unfortunately does exactly that. The key conclusions in the article's abstract are different from those of the patient summary in the same issue (2). The conclusion of the abstract says “[n]o suggestion of a decreased risk for CHD was found within the first 2 years of estrogen plus progestin use, including in women who initiated therapy within 10 years after menopause. A possible cardioprotective effect in these women who initiated therapy closer to menopause became apparent only after 6 years of use.” This message on risk for CHD seems neutral and perhaps even a bit positive.
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