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To the Editor: Dr Rossouw and colleagues¹ analyzed postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause; they used combined data for conjugated equine estrogen (CEE) therapy and CEE plus medroxyprogesterone acetate (CEE + MPA) from the Women's Health Initiative (WHI). The hazard ratios (HRs) for coronary heart disease (CHD) based on years since menopause were 0.76 (<10 years), 1.10 (10-19 years), and 1.28 (20 years) (P for trend = .02). The corresponding values for CEE were 0.48, 0.96, and 1.12 (P for trend = .15); for CCE + MPA the estimates were 0.88, 1.23, and 1.66 (P for trend =.05).

For CEE + MPA, the HRs may have been overestimated.^2-3 At baseline, the women were informed that a primary outcome was CHD, and during follow-up 44% and 6.7% of the CCE + MPA and placebo recipients, respectively, became unblinded to treatment assignment, mostly because of persistent vaginal bleeding.⁴ After about 3 years of . . . [Full Text of this Article]

Samuel Shapiro, MB, FRCPE
samshap@mweb.co.za
Department of Public Health and Family Medicine
University of Cape Town Medical School
Cape Town, South Africa

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