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To the Editor: The Women's Health Initiative (WHI) investigators¹ stopped the estrogen plus progestin vs placebo arm of their study because they found that women receiving estrogen plus progestin had a significantly higher risk of breast cancer, coronary heart disease (CHD), stroke, and pulmonary embolus (PE). The authors claim, based on these results, that this hormone replacement therapy (HRT) should not be recommended for primary prevention of CHD in women.

Clinical events, such as those the authors measured, occur well after the first onset of atherosclerosis. Thus, targets in the primary prevention of CHD should address prevention of plaque formation, as well as prevention of plaque rupture. To test the hypothesis that HRT reduces the risk of atherosclerosis, an optimal primary prevention trial would randomize younger, newly menopausal women to HRT or to placebo. They would then be prospectively assessed for atherosclerosis and clinical events.

In contrast, almost half the . . . [Full Text of this Article]

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