Plan Wood Carving Bench Portable

Will Without the risk of coronary heart disease in women treated with hormone therapy?

Will Without the risk of coronary heart disease in women treated with therapy hormonal?
May 26, 2010
Will Without the risk of coronary heart disease in women treated with hormone therapy?
Jaime Urdinola
MD Medical Association of the Andes - AK 9116 20 CS 326 - Bogotá DC Colombia

Phone 571/215 23 00 e-mail: jaimeurdinolamd@gmail.com

blogger: http://www.urdinola.blogspot.com www.urdinolamenopausia2.blogspot.com

Symposium / Luncheon on Women's Health and Menopause Medical Association

Andes

Board Room - First Floor - Wednesday May 26 2010

A new analysis from the Women's Health Initiative (WHI = Women's Health Initiative) ha encontrado, que entre las mujeres menopáusicas recientes, la terapia hormonal (TH) con estrógeno + progesterona aumenta ligeramente el riesgo para enfermedad cardíaca coronaria (ECC) dentro de los primeros años de uso. Pero el aumento hallado no fué estadísticamente significativo 1 .
El autor principal Dr. Sengwee Darren Toh, de la Escuela Médica de Harvard y del Instituto del Cuidado del Peregrino de la ciudad de Boston en EE.UU. manifestó que el análisis se enfocó en las mujeres menopáusicas recientes “porque ellas son las que con mayor probabilidad utilizan la terapia hormonal”. Este aumento leve aunque no significativo, de alrededor del 29 % durante los First 2 years of use, disappeared after 6 years of use, and in fact, the researchers then used this period identified a cardioprotective effect of hormone therapy in this group of women. But given that today women use hormone therapy for less than 6 years, these women can not expect this cardioprotective effect is present in them.
These findings support the recommendations of the FDA (Federal Food and Drug U.S.) for women taking HRT if needed, to relieve symptoms of menopause, but their use should be made when it has been termed "the lowest dose for the shortest time possible," somewhat vague implicit in this definition.

further research: the result varies with HT according to time and proximity to menopause?

Toh explained that he and his group were tempted to review the WHI data 2 because "we wanted to bring to light and see if the effect of HT on risk changed over time and according to proximity to the time of menopause. " This was partly stimulated considering the so-called "Hypothesis of Opportunity" 3 , which suggests that the effects of HRT vary depending on when the woman starts treatment. According to this hypothesis, HT may reduce the risk for CHD among younger women who do not have advanced atherosclerotic plaque, but instead may accelerate as the ECC in older women, or those with advanced lesions . Toh and her colleagues also adjusted data from the WHI regarding adherence to treatment in their analysis, since the lack of compliance was a major problem in this study, in accordance with his explanations. Approximately 40% of women had suspended 80% of the assigned treatment medication in the sixth year. A standard approach to intention to treat, which makes no adjustment grip incomplete, can lead to misleading results.

Overall, 16 608 women in the WHI study 4 , who were randomized to receive 0.625 mg conjugated equine estrogen + 2.5 mg medroxyprogesterone acetate (n = 8506) or placebo (n = 8 102 ), Toh and colleagues found that compared with non-use of HT, the hazard ratio for CHD for the continued use of HT was 2.36 for the first 2 years of use and 1.69 for the first 8 years. But recently menopausal women, within the first 10 years of menopause, the hazard ratio was 1.29 during the first 2 years and 0.64 during first 8 years of continuous use of HRT (n = 2782) vs. Placebo (n = 2712). Free survival curves of ECC for the continued use of TH and non-TH using crossed about 6 years of study. Toh and colleagues also combined these numbers with data from the Nurses 'Health Study (Nurses') 5 to make more robust the analysis, finding that the results did not change substantially and that the crossing of the curves survival occurs in the latter study at 3 years.

In the early years of recent menopausal women no real increased risk, but there was no cardioprotection

It confirmed the findings of WHI a few years ago, the different statistical analysis, finding that although it is possible that younger women get the benefit of HT based on the hypothesis of Opportunity, not seems to happen within the first years of use. Therefore, according to Toh and colleagues, "an expected reduction in risk of CHD should not be a consideration for the initiation of HT in younger postmenopausal women." These data suggest that there is a significantly increased risk in this group of young women, but otherwise there was not a cardioprotective effect during these early years. It also clarifies that this group of young women in the WHI study was not as large as desirable, so that did not acquire the necessary statistical power for these findings were entirely accurate. But anyway emphasizes that the group of WHI study data is best found on this topic, so that we have analyzed the most appropriate form has been possible. In addition, women in this age group currently using HRT for a short period of time. References


1 - Toh S, Hernandez-Diaz S, Logan R, Rossouw JE, Hernán MA. Coronary Heart Disease in Postmenopausal Recipients of Estrogen Plus Progestin Therapy: Does the Increased Risk Ever Dissappear ? Ann Intern Med. 2010; 152: 211-7.
2- Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, Jackson RD, Beresford SA, Howard BV, Johnson KC, Kotchen JM, Ockene J; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. 2002; 288: 321-33.
3- Manson JE, Bassuk SS. Invited commentary: hormone therapy and risk of coronary heart disease why renew the focus on the early years of menopause? Am J Epidemiol. 2007; 166 :511-7.
4- Manson JE, Hsia J, Johnson KC, Rossouw JE, Assaf AR, Lasser NL, Trevisan M, Black HR, Heckbert SR, Detrano R, Strickland OL, Wong ND, Crouse JR, Stein E, Cushman M, Women's Health Initiative Investigators. Estrogen plus progestin and the Risk of coronary heart disease. N Engl J Med 2003; 349: 523-34.
5 - Hernán MA, Alonso A, Logan R, Grodstein F, Michels KB, Willett WC, Manson JE, Robins JM. Analyzed Observational studies like randomized experiments: an application to postmenopausal hormone therapy and coronary heart disease. Epidemiology. 2008, 19: 766-79.

If you have any comments, questions or concerns, you can "click" on comments and sending your message. Or if you prefer, can send comments, questions or concerns e-mail jaimeurdinolamd@gmail.com