[Lessons from the Women's Health Initiative (WHI) using hormone replacement therapy with regard to heart disease--the dream that has been broken?].
The Women's Health Initiative (WHI) a double-blind, placebo-controlled trial studying the effects of continuous combined estrogen-progestin regimen (CEE 0.625 mg plus 2.5 mg MPA daily), was stopped prematurely on the basis of a slight increase in the risk of invasive breast cancer, myocardial infarction and stroke. The study was not planned to examine other important aspects of HRT treatment, such as menopausal symptoms and quality of life, since the CEE only arm of the study was not terminated, it is possible that the specific drug tested in the study had different effects on outcome than other preparations available in the market. One should remember that many previous observational studies actually demonstrated cardiovascular benefits in women using other types or regimens of hormones. There seems to be a consensus on the interpretation of the WHI trial: 1) hormones are the best treatment for symptomatic women since there are no real alternatives; 2) women who use HRT for more than 5 years should discuss the latest data with their physician, in order to consider their individual risk-benefit equation; 3) it is logical to prefer hormones, which are different from CEE plus MPA daily.
Pines
Amos
A
Department of Med T Ichilov Hospital, Tel Aviv.
D001943:Breast Neoplasms / Q000453:epidemiology / Q000517:prevention & control; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016387:Women's Health