Bioidentical Hormones - U.S. Senate Special Committee on Aging
Bioidentical Hormones - U.S. Senate Special Committee on Aging
Bioidentical Hormones - U.S. Senate Special Committee on Aging
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202<br />
HORMONE THERAPY USE AND RISK OF CARDIOVASCULAR DISEASE<br />
tial modificati<strong>on</strong> of horm<strong>on</strong>e effects by COMMENT have adequate statistical power to asage<br />
or years since menopause. Other Although not statistically significant sess outcomes in the women aged 50<br />
models suggested a time-dependent these sec<strong>on</strong>dary analyses suggest that to 54 years or less than 5 years since<br />
effect of horm<strong>on</strong>e therapy in the com- the effect ofhorm<strong>on</strong>es <strong>on</strong> CHD may be menopause. As previously reported.<br />
bined trials for CHD (but not stroke), modifiedbyyearssincemenopauseand CEE appeared to be associated with<br />
with higherrisks in the first 2years and by the presence of vasomotor symp- lower risk of CHD than CEE + MPA.'<br />
decreasing risk thereafter (P= .01). Even toms, with the highest risks in women Importantly, the risk of stroke was not<br />
though power was limited by small whowere20ormoreyearssincemeno- influenced by years since menopause.<br />
numbers of events, the directi<strong>on</strong> of pause (or aged 270 years). Cor<strong>on</strong>ary the presence of vasomotor sympt<strong>on</strong>s,<br />
time-dependent effects were similar heart disease tended to be n<strong>on</strong>signifi- ordrugregimen, althoughtherewasno<br />
within categories of age or years since cantly reduced by horm<strong>on</strong>e therapy in increased risk of stroke in women aged<br />
menopause, and there were no inter- younger women or women with less 50 to 59 years.<br />
acti<strong>on</strong>s of time-dependent effects <strong>on</strong> than 10 years since menopause, and the Our findings are c<strong>on</strong>sistent with find-<br />
HRs across the age or years since meno- risk of total mortality was reduced in ings from observati<strong>on</strong>al studies of the<br />
pause categories. women aged 50 to 59 years. We did not associati<strong>on</strong> of years sitce menopause<br />
Table 4. Cardiovascuitar and Global tnde" Events by Age at llaseline<br />
AUe Group at Randomiratio-<br />
6 9<br />
so-sa y<br />
8- y 70-79 y<br />
i ~~~~~I<br />
I I,<br />
No. of Cases No. ol Case No. of Cases<br />
I I ~ ~ ~ ,I ~ ~ ~ ~~~~I P<br />
Ha<strong>on</strong>r<strong>on</strong>e I-Hkrroie Ho ne Valuse<br />
Therapy Placebo HR Therapy Placebo HR Thery Pi ..ebo HR for<br />
(n . 4476) In . 4358) (95% Ct) (i = 6240) tn e61 22) (95% Ct) (n e3100) (n . 3053) (95% CQlO Teenat<br />
C-oNbned Tlals<br />
CtiDt 59 61 0.93 174 178 0.98 183 131 1.26 .16<br />
Stroke<br />
Totalimslty<br />
Global rda§<br />
44<br />
69<br />
278<br />
37<br />
g9s<br />
278<br />
1.13<br />
(0.73-1.76)<br />
070<br />
(0.5-0.98)<br />
0.98<br />
(081-.14)<br />
156<br />
240<br />
717<br />
102<br />
225<br />
661<br />
1.50<br />
(1.17-1-92)<br />
1.05<br />
(087-1 26)<br />
1.08<br />
0.97-1 20)<br />
127<br />
237<br />
608<br />
100<br />
208<br />
528<br />
1.21 .97<br />
(0.93-1.59)<br />
114 .06<br />
(0.94-1.37)<br />
1,14 .09<br />
102-1.29)<br />
CHLlt<br />
GEE Placebo<br />
(n1637) tn=16731<br />
21 34 083<br />
036-1.09)<br />
CEE Trial<br />
GEE Placebo CEE<br />
( I.n387) l 2465) (n.1286)5<br />
96 106 0.94 84<br />
(0.71-1.24)<br />
Placebo<br />
jnl291)<br />
77 1.13<br />
(02-i s4)<br />
.12<br />
Stroke<br />
Tate]ornality<br />
Ook~oalsto-fe<br />
18<br />
34<br />
"14<br />
21<br />
48<br />
10<br />
0.89<br />
(0.47-1.69)<br />
0.71<br />
(0.49-1.11)<br />
0.82<br />
(.64-1.05)<br />
84<br />
129<br />
333<br />
54<br />
131<br />
342<br />
1.62<br />
(1.15-2.27)<br />
1.02<br />
(0.0-1.30)<br />
1.01<br />
(0.6-1.17)<br />
66<br />
134<br />
300<br />
52<br />
113<br />
262<br />
1.21<br />
(0584-1.75)<br />
1.20<br />
(0.93-1.55)<br />
1.16<br />
(0.981.37)<br />
.62<br />
.18<br />
.01<br />
CEE, MPA Tria<br />
CEEvMPA Placebo CEE+MPA Placebo CEE+MPA Placebo<br />
(I. -28391 (26831 (n 38531)n=.3657) (n.1814) (n. 1762)<br />
CHDt 38 27 1.29 78 72 1.03 79 54 1.48 .70<br />
(0.792. 21 (0.74-1.43) (1o04_2.11)<br />
Siroke 26 18 1.41 72 48 1.37 61 48 1.21 .<br />
(0.7-2.65) (0951-97) (0.82-I.78)<br />
Tote4 m<strong>on</strong>ttiy 35 47 0.69 III 94 1.09 103 95 1.06 .19<br />
(0.44-1.07) (0.3-1 .44) (090-1 41)<br />
Global inttex§ 164 138 1.10 384 319 1.15 306 266 113 .98<br />
(087-1.39 (0899-1.34) (0.9- 5133)<br />
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(tD hrs MXlbO and ol, 115n<br />
I<strong>on</strong>s *oaIe txcttrentrtm ago 81.50.0,00004049<br />
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