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Postmenopausal Estrogen and Prevention Bias

Elizabeth Barrett-Connor, MD
[+] Article, Author, and Disclosure Information

Grant Support: By National Institutes of Health grants AGO 7181 and HL 40207.

Requests for Reprints: Elizabeth Barrett-Connor, MD, Department of Community and Family Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0607.

Current Author Address: Dr. Barrett-Connor: Department of Community and Family Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0607.

Ann Intern Med. 1991;115(6):455-456. doi:10.7326/0003-4819-115-6-455
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This excerpt has been provided in the absence of an abstract.

In the last decade many investigators reported that postmenopausal women taking estrogen were at reduced risk for cardiovascular disease compared with women not taking estrogen (1). Many clinicians in the United States now believe that replacement estrogen prevents heart disease. The results are fairly consistent and biologically plausible. Replacement estrogen lowers low-density lipoprotein (LDL) cholesterol and raises high-density lipoprotein (HDL) cholesterol (2) and may also lower blood pressure, blood glucose, and plasma insulin (3). If estrogen does prevent heart disease, the quantitative benefit would far exceed any known or postulated adverse events, including cancer (4).

Observational studies suffer from several




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