American Journal of Epidemiology Advance Access originally published online on July 23, 2007
American Journal of Epidemiology 2007 166(5):511-517; doi:10.1093/aje/kwm213
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Invited Commentary: Hormone Therapy and Risk of Coronary Heart Disease—Why Renew the Focus on the Early Years of Menopause?
1 Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
2 Department of Epidemiology, Harvard School of Public Health, Boston, MA
Correspondence to Dr. JoAnn E. Manson, Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Avenue East, Boston, MA 02215 (e-mail: jmanson{at}rics.bwh.harvard.edu).
Received for publication April 6, 2007. Accepted for publication June 19, 2007.
After the initial report from the Women's Health Initiative estrogen-progestin trial, which found that menopausal hormone therapy was associated with an increased risk of coronary heart disease in the overall cohort (age range: 50–79 years; mean age: 63 years), researchers took a closer look at the data from this and other studies, focusing on the timing of initiation of such therapy. The results suggest that hormone therapy may have a beneficial effect on the heart if started in early menopause, when a woman's arteries are still likely to be relatively healthy, but a harmful effect if started in late menopause, when advanced atherosclerosis may be present. The implication of the timing hypothesis for clinical practice is not that recently menopausal women be given hormone therapy for coronary heart disease prevention but rather that clinicians can be reassured about cardiac risks when considering short-term use of hormone therapy for vasomotor symptom relief in such women. The reduction in vasomotor symptoms must be weighed against other risks and benefits of treatment, but coronary disease is typically not a major factor in the equation for women who are recently menopausal.
coronary disease; estrogens; hormone replacement therapy; menopause; observational studies; progestins; randomized controlled trials
Abbreviations: CACS, Coronary Artery Calcium Study; CHD, coronary heart disease; CI, confidence interval; HERS, Heart and Estrogen/progestin Replacement Study; WHI, Women's Health Initiative
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