RSS Feeds
Postmenopausal Hormone Therapy and Cardiovascular Disease
- Francine Grodstein, ScD;
- JoAnn E. Manson, MD; and
- Meir J. Stampfer, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
IN RESPONSE:
We appreciate Dr. Kessler's attempt to further clarify the complicated decisions relating to HRT in postmenopausal women. However, we would like to stress that all such attempts (including our own) must be interpreted with great caution. Calculations such as those presented by Dr. Kessler will vary substantially depending on the individual woman's risk factors and assume that the relative risks applied are perfectly accurate and valid. In particular, the relative risk associated with 0.3 mg of estrogen and stroke in the Nurses' Health Study is based on relatively few stroke cases and thus is unstable (that is, the confidence interval surrounding the estimate is wide). Furthermore, HRT has been associated with a variety of risks and benefits (1), such as decreased risk for osteoporosis and increased risk for breast cancer and pulmonary embolism. Therefore, a completely informative calculation would necessarily incorporate many diseases and conditions besides cardiovascular disease.
As we explained in our article, hormone status was assigned at the start of every 2-year follow-up period to maintain the prospective nature of the study. Thus, Drs. Otto and Parhofer are correct in suggesting that our analysis could have assigned some women who had a cardiovascular event after very short-term HRT to the category of “never use.” Clearly, given the results of the HERS trial (2) and the press release from the Women's Health Initiative, we were concerned about this issue when originally conducting our analysis of HRT and cardiovascular disease in the Nurses' Health Study. While we could not eliminate the problem, we did examine how many patients in our study reported not using hormones at the start of the time period in which they developed cardiovascular disease but reported current or past hormone use on their subsequent questionnaire 2 years later. We found that only a small percentage of the patients assigned to the “never use” category might have had an event shortly after starting HRT, and thus it is highly unlikely that this could have substantially influenced our results.
Francine Grodstein, ScD
JoAnn E. Manson, MD
Meir J. Stampfer, MD
Harvard Medical School and Harvard School of Public Health; Boston, MA 02215
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
