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(Circulation. 2003;107:2.)
© 2003 American Heart Association, Inc.

Hormone Replacement Therapy and Heart Disease

Replacing Dogma With Data

David M. Herrington, MD, MHS

From the Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to David M. Herrington, MD, MHS, Department of Internal Medicine/Cardiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157. E-mail dherring@wfubmc.edu

Key Words: Editorials • hormones • cardiovascular diseases • epidemiology • diabetes mellitus

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In 1966, Dr Robert A. Wilson wrote an influential book entitled Feminine Forever that extolled the virtues of postmenopausal hormone replacement therapy (HRT).¹ Over the next 3 decades, use of HRT to preserve the health and vitality of postmenopausal women became one of America’s most popular medical treatment paradigms. The enthusiasm for HRT was greatly enhanced by the perception that it could lower a woman’s risk for heart disease, perhaps by as much as 50%. This notion was fueled, in part, by the remarkably consistent finding from observational studies that postmenopausal users of HRT had substantially lower rates of cardiovascular events than non-users.² Promising in vitro and animal model studies and favorable effects of HRT on cardiovascular risk factors added credibility to the observational study findings.³ By the mid-1990s, these cardiovascular and other data, coupled with effective relief of postmenopausal symptoms, helped make HRT the most frequently prescribed drug in the United States, despite the absence of any large, randomized clinical trials documenting its net clinical benefits or risks.

See p 43

In 1998, however, the HRT paradigm began to crumble with the release of the Heart and Estrogen/progestin Replacement Study (HERS). In this, the first major randomized clinical trial of HRT for secondary prevention of heart disease, there was no overall benefit of hormone treatment, but there was an unexpected pattern of increased risk during the first year of follow-up.⁴ Since then, 7 additional randomized clinical trials, testing a variety of hormone replacement regimens, also found no benefit of . . . [Full Text of this Article]

Related Article:

Current Use of Unopposed Estrogen and Estrogen Plus Progestin and the Risk of Acute Myocardial Infarction Among Women With Diabetes: The Northern California Kaiser Permanente Diabetes Registry, 1995–1998

Assiamira Ferrara, Charles P. Quesenberry, Andrew J. Karter, Catherine W. Njoroge, Alice S. Jacobson, and Joseph V. Selby
Circulation 2003 107: 43-48. [Abstract] [Full Text]

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