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To the Editor: Dr Zandi and colleagues¹ found that HRT nonusers were significantly older than HRT users and had a 300% higher incidence of AD. Women with missing data on HRT use were even older than nonusers and had an additional 250% higher incidence of AD. Thus, it appears that these age differences were responsible for most of the increased incidence of AD. It is possible that at least some of the older women did not recall their HRT use simply because they were at the early stages of AD.

There may be other unmeasured selection biases among HRT users, who tend to be healthier than nonusers. Use of HRT is strongly associated with demographic and health-related factors.² Initiation of HRT is associated with being encouraged by a physician and believing in the preventive efficacy of HRT.³ Many of these demographic, health issues, and prevention measures and beliefs are also . . . [Full Text of this Article]

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