A "window of opportunity:" the reduction of coronary heart disease and total mortality with menopausal therapies is age- and time-dependent.
The totality of data indicates that the "window of opportunity" for reducing coronary heart disease (CHD) and overall mortality is initiation of hormone therapy (HT) within 6 years of menopause and/or before 60 years of age. Reduction of CHD risk and overall mortality with prolonged HT use in this subgroup of women is consistent across randomized controlled trials and observational studies. As such, HT use for 5 to 30 years in postmenopausal women who initiate HT in their 50s substantially increases quality-adjusted life-years (QALYs) by 1.5 QALYs and is highly cost-effective at $2438 per QALY gained. Cumulated randomized controlled trial results indicate a consistency along with observational data that young postmenopausal women with menopausal symptoms who use HT for long periods of time have lower rates of CHD and overall mortality than comparable postmenopausal women who do not use HT.
Hodis
Howard N
HN
Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. athero@usc.edu
Mack
Wendy J
WJ
D000367:Age Factors; D000818:Animals; D003327:Coronary Disease / Q000401:mortality* / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy / Q000379:methods* / Q000639:trends; D005260:Female; D006801:Humans; D008593:Menopause / Q000187:drug effects* / Q000502:physiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D013997:Time Factors