Bioidentical Hormones - U.S. Senate Special Committee on Aging

207
HORMONE THERAPY USE AND RISK OF CARDIOVASCULAR DISEASE
ting of randomized controlled Irials,
thus avoiding some of the potential
biases of observational studies. The
by distantce front menopause, with no apparent
increase in CHD risk for women
close to menopause, and particularly high
a Wnnhatta rontnr & Canin ned entewag fund
rig fit Paee. Nneof ate tle, authors reported
disnnoures.
F.ading/Sappont The Womens Heatth IicitatiT prt-
conclusions relating to harm in
women more distant from menopause
are more robust because of the larger
numbers of clinical evenis- The conclusions
based on the analyses of
nsks in women who are distant from
menopause and have vasomotor symptoms
We did not identify any subgroup
with reduced risk of CHD, although
total mortality was reduced
gcrn isniaded by tie Natuial Heart. Lang. aid lied
Irirnnte, NabtcetInitutr tof Heath. OnaDrp.Aentof
Heatah iad Hnac Scramc.. The study daugsee sap.
plied bi Wyeth Rseasch (st D-iOds. Pat.
Rote ofth Sp-nean: The Natlaalinrdtiirna of Heaith
had inpuSt int dign and ondact of the study: Wi-
Ierlin management, anis and interpreratlbn ot
women closer to menopause are less
robust due to smaller numhers, as are
among women aged 50 to 59 years. The
findings regarding potential modifying
the data: nnd prepna-iiin of the ciacarrpt. Wyeth
did not participate rn any aspeat af thed rec
the analyses itivolving vasomnotor
symptoms. Time of menopause may
not be accurately ascertained in
effects of vasomotor symptoms warrant
further study. The absence of excess absolute
risk of CHD and the suggestion
Wmt t-nctigaties
Prnxant Olfti. Nirattl Heart. Lung. and Ilood Institrte
Bathscda. Md ttitabniai NatIl. Mtqcns Rassara.
Shan Ludbm. bada Ptn. lean McGo-an
women who hase undergone a hystereciomy.
Nonadherence may have
allected the results At the end of the
of reduced total mortality in younger
women offers some reassurance that hormones
remain a reasonable option for the
Lesni Ford, and Nanny Glelr).
CitnkI Cirdinting Censter: Fred Hatchnrsn CanitinseaRCh
Center. Seatte. wash lRoss P-tiirn Ga.nrt
Ardensan. Aedrea LCcrni Chadies L. Koupnr.
trials, 54% of participants were no
longer taking CEE and 42% were no
short-ierm treatment of menopausal
symptoms, but does not necessarily im-
Lrg,. Ruth E. PattrA-n.wAn;nre cei.): Wake Faret
Wni-rty School of Medicine Winsltn tSme, NC
(Saty Shsrkert) Medial Research Labs, Higiand
longer taking CEE + MPA. The results
are derived from relatively short durations
of treatment but the average of 4
0o 5 Years of receiving treatment in the
trials is longer than most women
ply an absence of harm over prolonged
petiods of hormone use. In contrast, risk
of stroke did not depend on years since
menopause or the presence of vasomoloe
symptoms. The findings are consis-
Heights Ky ff- Stric)t Uciaenity of Caidinna at
Sacn Fr-nasca, he Fracusco ISteten C-mgins).
CI0ninI Centers Albert Ensta Coliege of Medince
,rma. NY ISyhia Wassertheil-Snlert) layltn
Calg at Meddnfe. Hearten. Tea tecider Haysi.
Drtighm and W-iren s Hospital. Harvend Medicai
School, Bostn. Mass ionen Mansa l-ie Un.iwvould
need for treatment of vasomotor
symptoms. Multiple statistical tests
were performed, raising a distinct possibility
that several of the positive findings
occurred by chance. The possibility
of type I error is increased by the
fact that these analyses were partly
stimulated by the initial findings from
the trials. The results are dependent
on the analytic approach used, which
differs in this compared with previous
publicationis from the WHI trials. In
previous WHI studies using continuous
variables, the significance of the
interaction of years since hysierectomy
on CHD in the trial of CEE was
Pwty, P-idess, Rt tientA..We R. A5Uf ;: Ersy unstent
with current recommendations that iet. Atlanta. cratcanene Philips); Fred Hachihn-
hormurone therapy be used in the shortson Cann-e Research Center, Seattie, Wash IhrSLy
ee-sford)i Grage Washhngton Uineity Midiat
term for relief of moderate or severe va-
Cser. Waslingitn, DC tIadirh Hse.): La. Agetes
somotor symptoms, but not in the longer blomedicil Research Ins'ite at Habo-iUCLA MA did-
term for prevention ofcardiovAsculardisctl Center, T.n-ran Ceidf (Ra.ian Chteb.nkki)t Kaiin
Pecanne-te Center for Health Research. PoateascrNN
Land, Ore (Etnlyc Whitlock): Cirns Peraninate
Drcisi- of Res-h, Oaklnd. 1 Caif (8ette caa);
ta.rMtAiasI Naed Hert Laard Mlirid i Medialctl degenf iwaansn. tatrknaaknn etianetaan
stitute, snieda, Md (Dr R.-a)aw; Fred Hutchirmn ky Kotcihm-n MedSt Renr- h Irfitrt./Haard tir-
C-r. DhCesCerr,,rSiaiter .Wtsh (D P.prnirind aerit Wainsoe-n. DC (lCub V. Hianrd.: North-
LaCani nd Ms Wa), OW.i; n of prerennef n M i idme, iestern Unetniy, Chtaago/Nacstn, IIl (Lnda Van
Br a nd wr-e Hospital Hm3 Motinal drhool, H-a) Rush Mednat GCnter,. Chitag, ll (iensyBlacirk)
lostO Mass (D, Macson; DOep.rrc tsao ObsttreisSttaaoad
Pierentan Reeaih Ceeter. Stafed. Caart
aiWd Gynmoagy and wane- s Healuh. Abeer Ent (Marcda L. Stitnnick); State Unhenity ot New Yoek
caotlge of Madaie. New Youk, NY tD, Bradi: On- at Stcy Brnok (Dt othy Lt.n) OhhI State Urinepar.tnr
t Obftebtns and Gyneciogy. Mednai Colhsity,
Coibasc(nRei-iclackr nl, Untenity a Aa-
lege of Wrsaatsii Mhuukee (D, 6naie0i DOstn bmn. Ibisminghm (C-a E. Lesis). Uariebtyif Ard-
of W rmc Is Health Iftern Medrice, Maso COd,, nu. Tucs.n/Phoenib hansen T i-iSfrd.) Univrenity
Scottsidae. Art tO, Ki)t mex' centee tar crinn Re- atlaitainol8utaea NYtieanwacsaatid-Mndbnt-in
search, ersrty of Minnesot, Mirnetratr(3s Mar- yesib of Caftia at Dnais. Streream tstnter Rob-
P= 06 compared with P= .15 for years
since menopause in the current analysis
using coded vanables.' In the trial
of CEE + MPA, the significance for
years since menopause changed from
P=.33 to P= 05.' Only one form of
oral estrogen and one forni of oral
progestin taken daily were included in
the trials, and it may be that different
results wotld have been obtained if
other regimens (eg, trantsdermal estraaht
,e-t etatM ietd .Sitalrd un-nnity. Palo bnsct Uniersity of C.asisif a, erine (F. Atac Hub-
Alto, Ca e(Dr stefakk).
bell, Unirenity of CaQfan. Los Angites l H1ard
Aithor Canaribtions Dr R-.soaw had Nttl ..i. to hrddl: UIneri-ty oi C.itf-ai at Stn Diegoi LaJorar
al of the data rn the study nd taker respao-inlity tor Chlai Vera iRfbert 0. Langer): Unenisity of COnn-
the atetiy if the data and the acaracy of ttie data nab. Cmdnnti, Ohio IMargery Geat; U eety nof
aaasir
Fkik5a. G. kA/ajacksoasc (Marian. ULnadce, Unstcytozpt
i nddeiarg: Rasrac, PnemteMaan, Yenity of Hlial. Honolulu (DIad Cuabl; Utnhenity
arad, annabei
of aea, i...a COti/D-O npet (Robett Walla.cd Ue -
Acquiritan oa data. Pentice. Macsan, lrid, K., esity of Maiarh--ettFta.n CUMni Wicestniia-
mCacin, Steacick.
dith Ockean); Unrnenity of Medicine and Dnatrisy
racsr n-dcrteipreeatiauto Riaraaa, P-sati, of N-w kney. Nsrawrk (Nonmen Lasser). Un-inty
Main, Wa, Barad, 8anitbi. LUcrei Mgalis. of Miami. Manti, R (Mary in O Saunan;) Unher-
omatcng oa tU.e .nnAnarpt Rosoarou w . CK. sIty of Miaerata. Mnnapails (Kicen Margolis). Ulu-
Cerra revisiao at tir inauiip t ar icprtani is erety of Nevada. Rern (Robert BncrX. Unenity
Wite-trat ca-tetr Prentice, Ma.can. Wvu, iarad, of Nbtah C-Iinc. Chapel Hit IGerardb Heiss)i Un-
icceaher, Ka, LaCoil, Magolis Stf tnickt etity of Pittsburgh. Pittsburgh. Pt (Lrwis K.Rei: Umdiol,
progesterone, or cyclic therapy) SlartisicaiNrlysis: P-entce. W, LaCri.
nensay of reT-esese Mniphis (Kteare C. latrsaci
were tested.
These analyses, although not defini-
Obtamned f-edmag: Rosauw, Prenetie Macsrn.
Stefninck.
Adccniairative. technical, or atecal supporit
U-neriy it Tenoas Health SMnnie Cente,. Sac Antono
(Robert rnyskhi: Unhnsity if VWIrani.. Madian
(CGoia C. Start.) Wake Forest Untaersity Scnan
tive, suggest that the health cotisequences
of hormone therapy may vary
Rac.s Prentice, Maniac
Study ripe-isiiei Rassaw. Magais.
Ftn ilt Distlsaens On LaCntit repoted sedg as
of Medicine, Wlnston-Saer. NC (Denlse 8nndsl
Wayne State nneanty Schoi of Medikle/Hatani
Hospital. Detrnit. Mich (Susr.n H-ndnit.
1476 IAMA, Apriln. N007-Vot 297. No. 13(Renntedl r2007 Ain-tnria Mediea Aansoati... Atf eUhms 6 ened.
Doinetinded fbee ww.jana m.m at Nationatl Institute of lth. on Apnl 5. 2007