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To the Editor: Dr Rossouw and colleagues¹ conclude that use of estrogen among women aged 50 to 59 years may not increase CHD risk, based on combined data from the CEE and CEE + MPA trials of the WHI. However, temporal trends in the use of hormone therapy may complicate the interpretation of their data.

From the early 1980s to the mid-1990s, the prevalence of hormone therapy use among postmenopausal women in the United States increased significantly to approximately 30% among women aged 60 to 74 years and 47% among women aged 50 to 59 years.^2-3 In general, women receiving hormone therapy who subsequently developed breast cancer or venous thromboembolism would have been taken off this therapy permanently and would not have entered WHI, thus creating a "survivor effect" among previous hormone therapy users who did enter the trial. A hormone therapy survivor effect has been noted in previous analyses⁴ and is . . . [Full Text of this Article]

Lynn E. T. Shaffer, MS
shaffel@ohiohealth.com
OhioHealth Research Institute

Carl A. Krantz, MD
Riverside Methodist Hospital
Columbus, Ohio

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