Postmenopausal Estrogen and Prevention Bias

Abstract

Brief Report15 September 1991Postmenopausal Estrogen and Prevention BiasElizabeth Barrett-Connor, MDElizabeth Barrett-Connor, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-115-6-455 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn the last decade many investigators reported that postmenopausal women taking estrogen were at reduced risk for cardiovascular disease compared with women not taking estrogen (1). Many clinicians in the United States now believe that replacement estrogen prevents heart disease. The results are fairly consistent and biologically plausible. Replacement estrogen lowers low-density lipoprotein (LDL) cholesterol and raises high-density lipoprotein (HDL) cholesterol (2) and may also lower blood pressure, blood glucose, and plasma insulin (3). If estrogen does prevent heart disease, the quantitative benefit would far exceed any known or postulated adverse events, including cancer (4).Observational studies suffer from several...References1. Barrett-ConnorBush ET. Estrogen and coronary heart disease in women. JAMA. 1991;265:1861-7. CrossrefMedlineGoogle Scholar2. TikkanenNikkiläVartiainen MEE. Natural oestrogen as an effective treatment for type-II hyperlipoproteinaemia in postmenopausal women. Lancet. 1978;2:490-1. CrossrefMedlineGoogle Scholar3. Barrett-Connor E. Putative complications of estrogen replacement therapy: hypertension, diabetes, thrombophlebitis, and gallstones. In: Korenman SG, ed. The Menopause. Norwell, Massachusetts: Serono Symposia; 1990:199-209. Google Scholar4. ErnsterBushHugginsHulkaKelseySchottenfeld VTGBJD. Benefits and risks of menopausal estrogen and/or progestin hormone use. Prev Med. 1988;17:201-23. CrossrefMedlineGoogle Scholar5. CauleyCummingsBlackMascioliSeeley JSDSD. Prevalence and determinants of estrogen replacement therapy in elderly women. Am J Obstet Gynecol. 1990;163:1438-44. CrossrefMedlineGoogle Scholar6. Barrett-ConnorWingardCriqui EDM. Postmenopausal estrogen use and heart disease risk factors in the 1980s. JAMA. 1989;261:2095-100. CrossrefMedlineGoogle Scholar7. Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. New Engl J Med. 1980;303:1038-41. CrossrefMedlineGoogle Scholar8. HorwitzViscoliBerkmanDonaldsonHorwitzMurray RCLRSC. Treatment adherence and risk of death after a myocardial infarction. Lancet. 1990;336:542-5. CrossrefMedlineGoogle Scholar9. BergkvistAdamiPerssonHooverSchairer LHIRC. The risk of breast cancer after estrogen and estrogen-progestin replacement. N Engl J Med. 1989;321:293-7. CrossrefMedlineGoogle Scholar10. BergkvistAdamiPerssonBergstromKrusemo LHIRU. Prognosis after breast cancer diagnosis in women exposed to estrogen and estrogen-progestogen replacement therapy. Am J Epidemiol. 1989;130:221-8. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of California, San Diego; La Jolla, California. For the current author address, see end of text. 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II. 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A follow-up study among 1689 women aged 45–60 yearsEffects of estrogens on lipoprotein metabolism and cardiovascular disease in womenDo women taking hormone replacement therapy have a higher uptake of screening mammograms?CALCIUM, ESTROGEN, AND PROGESTIN IN THE TREATMENT OF OSTEOPOROSISPostmenopausal estrogen replacement: A long-term cohort studyImpact of the menopause on the epidemiology and risk factors of coronary artery heart disease in womenPostmenopausal estrogen and the risk of breast cancerCorrelates of Impaired Function in Older WomenHormonal Treatment of Postmenopausal WomenHormonal treatment for the climacteric: alleviation of symptoms and prevention of postmenopausal diseaseCoronary heart disease, the menopause, and hormone replacement therapy.Epidemiologic Studies on Ert and Cardioprotection: State of the Art on HRT and Cardiovascular DiseaseSex steroids and lipoprotein metabolismHormone replacement therapy: the need for reconsideration.Editor's note: Estrogen therapy for the prevention of coronary heart disease: What are the facts?Endocrine disordersThe Menopause: Health Implications and Clinical ManagementGender, Health, and Responsible ResearchThe epidemiology of osteoporosis5 Oestrogens and atherosclerotic vascular disease—lipid factors6 Epidemiological overview of oestrogen replacement and cardiovascular disease7 Hormone replacement therapy and cancerWinner of the Young Clinical investigater Manuscript Award: Hysterectomy Status and Preventive Health Behaviors in Older WomenPostmenopausal hormone replacement therapy.Do current regimes of hormone replacement therapy protect against subsequent fractures?The Prevention and Treatment of OsteoporosisEstrogen Therapy for Osteoporosis—Even in the ElderlySusan M. Ott, MDSafety of post-menopausal hormone replacementPostmenopausal Estrogen Therapy and Cardiovascular DiseasePostmenopausal Estrogen and Prevention BiasMaryann NapoliEvidence-Based Medicine and GeriatricsSpezielle therapeutische Probleme im höheren AlterPromoting Informed Decision Making: Hormone Replacement TherapyA Summary of the Evidence Relating Postmenopausal Hormone Use and Large Bowel Cancer Risk 15 September 1991Volume 115, Issue 6Page: 455-456KeywordsBlood plasmaCardiovascular therapyCholesterolEstrogensGlucoseHigh density lipoproteinInsulinLow density lipoproteinObservational studiesRisk management Issue Published: 15 September 1991 PDF DownloadLoading ...