Hormones To Prevent Coronary Disease in Women: When Are Observational Studies Adequate Evidence?

Editorials19 December 2000Hormones To Prevent Coronary Disease in Women: When Are Observational Studies Adequate Evidence?Deborah Grady, MD, MPH and Stephen B. Hulley, MD, MPHDeborah Grady, MD, MPHDrs. Grady and Hulley: University of California, San Francisco; San Francisco, CA 94105 and Stephen B. Hulley, MD, MPHDrs. Grady and Hulley: University of California, San Francisco; San Francisco, CA 94105Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-12-200012190-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail For many years, observational studies have reported that postmenopausal women who use estrogen have a lower rate of coronary heart disease than women who do not. Results of the Nurses' Health Study concerning this question were first published in 1985 (1) and were updated in 1991 (2), 1996 (3), and again in this issue (4). The main findings have not changed: Postmenopausal women who are current users of estrogen or estrogen plus a progestin have about a 40% lower risk for coronary disease compared with women who never used hormones. Many other observational studies have reported similar results (5), but ...References1. Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH. A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med. 1985;313:1044-9. CrossrefMedlineGoogle Scholar2. Stampfer MJ, Colditz GA, Willett WC, Manson JE, Rosner B, Speizer FE, et al . Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the nurses' health study. N Engl J Med. 1991;325:756-62. CrossrefMedlineGoogle Scholar3. Grodstein F, Stampfer MJ, Manson JE, Colditz GA, Willett WC, Rosner B, et al . Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N Engl J Med. 1996;335:453-61. CrossrefMedlineGoogle Scholar4. Grodstein F, Manson JE, Colditz GA, Willett WC, Speizer FE, Stampfer MJ. A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med. 2000;133:933-41. LinkGoogle Scholar5. Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, et al . Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117:1016-37. LinkGoogle Scholar6. . Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial. The Writing Group for the PEPI Trial. JAMA. 1995;273:199-208. CrossrefMedlineGoogle Scholar7. Mendelsohn ME, Karas RH. The protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999;340:1801-11. CrossrefMedlineGoogle Scholar8. Adams MR, Kaplan JR, Manuck SB, Koritnik DR, Parks JS, Wolfe MS, et al . Inhibition of coronary artery atherosclerosis by 17-β estradiol in ovariectomized monkeys. Lack of an effect of added progesterone. Arteriosclerosis. 1990;10:1051-7. CrossrefMedlineGoogle Scholar9. Walsh BW, Schiff I, Rosner B, Greenberg L, Ravnikar V, Sacks FM. Effects of postmenopausal estrogen replacement on the concentrations and metabolism of plasma lipoproteins. N Engl J Med. 1991;325:1196-204. CrossrefMedlineGoogle Scholar10. Benfante R, Yano K, Hwang LJ, Curb JD, Kagan A, Ross W. Elevated serum cholesterol is a risk factor for both coronary heart disease and thromboembolic stroke in Hawaiian Japanese men. Implications of shared risk. Stroke. 1994;25:814-20. CrossrefMedlineGoogle Scholar11. Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, et al . Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998;280:605-13. CrossrefMedlineGoogle Scholar12. Herrington DM, Reboussin DM, Brosnihan KB, Sharp PC, Shumaker SA, Snyder TE, et al . Effects of estrogen replacement on the progression of coronary-artery atherosclerosis. N Engl J Med. 2000;343:522-9. CrossrefMedlineGoogle Scholar13. Lenfant C. Statement from Claude Lenfant, MD, Director, National Heart, Lung, and Blood Institute, on preliminary trends in the Women's Health Initiative. National Heart, Lung, and Blood Institute Communications Office. 3 April 2000. Google Scholar14. Barrett-Connor E. Postmenopausal estrogen and prevention bias. Ann Intern Med. 1991;115:455-6. LinkGoogle Scholar15. Ettinger B, Pressman A. Continuation of postmenopausal hormone replacement therapy in a large health maintenance organization: transdermal matrix patch versus oral estrogen therapy. Am J Manag Care. 1999;5:779-85. MedlineGoogle Scholar16. . Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. N Engl J Med. 1980;303:1038-41. CrossrefMedlineGoogle Scholar17. Gallagher EJ, Viscoli CM, Horwitz RI. The relationship of treatment adherence to the risk of death after myocardial infarction in women. JAMA. 1993;270:742-4. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Drs. Grady and Hulley: University of California, San Francisco; San Francisco, CA 94105Corresponding Author: Deborah Grady, MD, MPH, Department of Epidemiology, University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, CA 94105.Current Author Addresses: Drs. Grady and Hulley: Department of Epidemiology, University of California, San Francisco, 74 New Montgomery, Suite 600, San Francisco, CA 94105. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoA Prospective, Observational Study of Postmenopausal Hormone Therapy and Primary Prevention of Cardiovascular Disease Francine Grodstein , JoAnn E. Manson , Graham A. 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