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10 Can Hormone Therapy Account for American Women's Survival Disadvantage?--Noreen Goldman
Pages 299-310

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From page 299...
... Although the Food and Drug Administration never approved Premarin or alternative forms of HT for the prevention of other chronic diseases, physicians began to widely prescribe it for these purposes because observational studies in the 1980s and 1990s suggested numerous health benefits, including cardiovascular disease and dementia prevention (Wysowski and Governale, 2005)
From page 300...
... have challenged findings from observational studies regarding the harm and benefits of long-term use of HT. Although both types of studies are in general agreement about its benefits for colorectal cancer and hip fracture and the increased risk associated with breast cancer, they have produced widely discrepant estimates for coronary heart disease or CHD (Grodstein, Clarkson, and Manson, 2003; Nelson et al., 2002)
From page 301...
... . In the second arm of the WHI, an average of 6.8 years of use of unopposed estrogens was significantly associated with increased risk of stroke and total cardiovascular disease, but not coronary heart disease (Women's Health Initiative Steering Committee, 2004)
From page 302...
... First, a secondary analysis8 based on pooled data from the two WHI trials yielded a significant trend in relative risk for CHD, with women at higher durations since menopause onset experiencing higher relative risks than those initiating use closer to menopause (Rossouw et al., 2007)
From page 303...
... Hormone therapy may have had a negative impact on diseases other than coronary heart disease. For example, estimates from both observational studies and randomized controlled trials indicate that HT use is 9Possible harmful effects of hormone therapy on cardiovascular health for women initiating use at older ages or durations since menopause onset may reflect the presence of significant vascular disease.
From page 304...
... . Although few researchers dispute the overall link between HT use and higher rates of breast cancer, it is important to keep in mind that death rates from breast cancer are far lower than those from cardiovascular disease, and thus the impact of HT-related breast cancer on overall adult female mortality is likely to have been modest.
From page 305...
... reveal only slightly lower proportions of postmenopausal women taking hormone therapy in the period 1996-2002 in Britain (36 percent) than in the United States (38-40 percent)
From page 306...
... , dose, and formulation (estrogen-progestin combination versus unopposed estrogens as well as type of progestin) of exogenous hormones vary across countries and may affect health outcomes (Fournier, Berrino, and Clavel-Chapeton, 2008; Manson et al., 2006)
From page 307...
... Analyses based on continued follow-up of participants in the randomized trials, smaller scale trials examining the biological pathways linking HT to cardiovascular disease, and observational studies are likely to provide updated and longer term estimates of the consequences of HT for health and survival in the United States and elsewhere. REFERENCES American College of Physicians.
From page 308...
... . Observational studies analyzed like randomized experi ments: An application to postmenopausal hormone therapy and coronary heart disease.
From page 309...
... . Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause.
From page 310...
... . Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial.


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