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Estrogen No Overall
Benefit in Disease Prevention
The latest analysis of data from the
Women's Health Initiative (WHI) shows that estrogen replacement
therapy after menopause doesn't improve long-term health. While
it decreases the risk of fractures, it increases the risk of stroke.
Also, the treatment has no significant
effect on coronary heart disease or death from all causes, according
to the new report.
"These data support the current
US Food and Drug Administration recommendations for postmenopausal
women to use (estrogen) only for menopausal symptoms at the smallest
effective dose for the shortest possible time," Dr. Garnet L.
Anderson of the Fred Hutchinson Cancer Research Center, Seattle,
and other members of the WHI Steering Committee write in this
week's Journal of the American Medical Association.
The part of the WHI that looked
at the effects of estrogen plus progestin therapy was halted early
in 2002 because the health risks of combined hormone replacement
therapy exceeded the benefits. The estrogen-alone wing of the
study was continued until February 2004, when the National Institutes
of Health found a significantly increased risk of stroke and advised
that the trial be terminated.
The estrogen-only trial included
nearly 11,000 women ages 50 to 79 with prior hysterectomy who
were randomly assigned to daily estrogen or to a matching dummy
pill.
During an average follow-up of
about 7 years, the occurrence of coronary heart disease in the
two groups was not statistically different.
Also, the occurrence of breast
cancer -- the main measure of safety -- was no different in the
two groups, statistically, although it was lower among those taking
estrogen.
However, the occurrence of stroke
was increased by 39 percent in the estrogen group, while fractures
due to osteoporosis were reduced by 30 percent.
There were 291 deaths in the estrogen
group and 298 in the placebo group.
Overall, the health risks and benefits
balanced out, the report indicates.
In an editorial, two epidemiologists
at the University of California, San Francisco, agree that hormone
replacement therapy is not the way to prevent chronic disease.
"Fortunately, there are other good approaches to preventing coronary
heart disease and fractures for which trials have found benefits
to outweigh harms," they conclude.
Reference
Source 89
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