Postmenopausal Estrogen and Prevention Bias

Brief Report15 September 1991Postmenopausal Estrogen and Prevention BiasElizabeth Barrett-Connor, MDElizabeth Barrett-Connor, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-6-455 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn 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...References1. Barrett-ConnorBush ET. Estrogen and coronary heart disease in women. JAMA. 1991;265:1861-7. CrossrefMedlineGoogle Scholar2. TikkanenNikkiläVartiainen MEE. Natural oestrogen as an effective treatment for type-II hyperlipoproteinaemia in postmenopausal women. Lancet. 1978;2:490-1. CrossrefMedlineGoogle Scholar3. Barrett-Connor E. Putative complications of estrogen replacement therapy: hypertension, diabetes, thrombophlebitis, and gallstones. In: Korenman SG, ed. The Menopause. Norwell, Massachusetts: Serono Symposia; 1990:199-209. Google Scholar4. ErnsterBushHugginsHulkaKelseySchottenfeld VTGBJD. Benefits and risks of menopausal estrogen and/or progestin hormone use. Prev Med. 1988;17:201-23. CrossrefMedlineGoogle Scholar5. CauleyCummingsBlackMascioliSeeley JSDSD. Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol. 1990;163:1438-44. CrossrefMedlineGoogle Scholar6. Barrett-ConnorWingardCriqui EDM. Postmenopausal estrogen use and heart disease risk factors in the 1980s. JAMA. 1989;261:2095-100. CrossrefMedlineGoogle Scholar7. Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. New Engl J Med. 1980;303:1038-41. CrossrefMedlineGoogle Scholar8. HorwitzViscoliBerkmanDonaldsonHorwitzMurray RCLRSC. Treatment adherence and risk of death after a myocardial infarction. Lancet. 1990;336:542-5. CrossrefMedlineGoogle Scholar9. BergkvistAdamiPerssonHooverSchairer LHIRC. The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med. 1989;321:293-7. CrossrefMedlineGoogle Scholar10. BergkvistAdamiPerssonBergstromKrusemo LHIRU. Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy. Am J Epidemiol. 1989;130:221-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of California, San Diego; La Jolla, California. For the current author address, see end of text. 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