Home Journal Excerpts HRT: Heart, Breast Cancer, Gallbladder Disease
HRT: Heart, Breast Cancer, Gallbladder Disease
whiConclusions. - During an average follow-up of 4.1 years, treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease. The treatment did increase the rate of thromboembolic events and gallbladder disease.

Comment:

Here is another case where a medical assumption was made and presented to the public before a well-structured study was performed to prove out that assumption. In this case it was assumed that HRT [Hormone Replacement Therapy] would reduce the incidence of heart disease. People were told and placed on this medical regimen with everyone believing that they were preventing heart disease. In fact it did not, and unfortunately it increased venous thromboembolic events and gallbladder disease.

A more recent study indicates again the HRT greatly increases the risk of getting breast cancer; with a 2 to 3 fold increased risk of lobular cancer. And as stated, "A true increase in the risk of lobular breast cancer could have implications for screening, because lobular carcinomas are relatively more difficult to palpate and more difficult to diagnose by mammography."

And again with many safe, natural, and proven alternatives to preventing heart disease we need to emphasize those instead of always focusing on a pharmaceutical solution.


Hormone Replacement Therapy in Relation to Breast Cancer PDF Print E-mail
Wednesday, 13 February 2002 00:00
"Context - Studies of long-term hormone replacement therapy (HRT) suggest an associated increased risk of breast cancer, but whether this association differs according to histologic type of cancer has not been extensively studied."

"Objective - To determine whether the association between HRT and risk of breast cancer varies by HRT formulation and differs across histologic cancer types."

"Design, Setting, and Participants - Nested case-control study among 705 postmenopausal women enrolled in the Group Health Cooperative of Puget Sound (GHC) who were aged 50 to 74 years and had primary invasive breast cancer diagnosed between July 1, 1990, and December 31, 1995 (cases), and 692 randomly selected aged-matched female members of GHC (controls)."

"Main Outcome Measure - Incidence and type of breast cancer by duration of HRT use in the 5-year period ending 1 year before diagnosis, which was ascertained from computerized pharmacy records."

"Results - The incidence of breast cancer, all histologic types combined, was increased by 60% to 85% in recent long-term users of HRT, whether estrogen alone or estrogen plus progestin. Longer use of HRT (odds ratio [OR], 3.07 for 57 months or more; 95% confidence interval [CI], 1.55-6.06) and current use of combination therapy (OR, 3.91; 95% CI, 2.05-7.44) were associated with increased risk of lobular breast cancer. Long-term HRT use was associated with a 50% increase in nonlobular cancer (OR, 1.52 for 57 months or more; 95% CI, 1.01-2.29)."

"Conclusion - Our data add to the growing body of evidence that recent long-term use of HRT is associated with an increased risk of breast cancer and that such use may be related particularly to lobular tumors."
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Randomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women PDF Print E-mail
Wednesday, 19 August 1998 00:00
"Objective. - To determine if estrogen plus progestin therapy alters the risk for CHD [Coronary Heart Disease] events in postmenopausal women with established coronary disease.

Design. - Randomized, double-blind, placebo-controlled secondary prevention trial.

Setting. - Outpatient and community settings at 20 US clinical centers.

Participants. - A total of 2763 women with coronary disease, younger than 80 years, and postmenopausal with an intact uterus. Mean age was 66.7 years.

Intervention. - Either 0.625 mg of conjugated equine estrogens plus 2.5 mg of medroxyprogesterone acetate in 1 tablet daily (n=1380) or a placebo of identical appearance (n=1383). Follow-up averaged 4.1 years; 82% of those assigned to hormone treatment were taking it at the end of 1 years, and 75% ad the end of 3 years.

Main Outcome Measures. - The primary outcome was the occurrence of nonfatal myocardial infarction (MI) or CHD death. Secondary cardiovascular outcomes included coronary revascularization, unstable angina, congestive heart failure, resuscitated cardiac arrest, stroke or transient ischaemic attack, and peripheral arterial disease. All-cause mortality was also considered.

Results. - Overall, there were no significant differences between groups in the primary outcome or in any of the secondary cardiovascular outcomes: 172 women in the hormone group and 176 women in the placebo group had MI or CHD death (relative hazard [RH], 0.99; 95% confidence interval [CI], 0.80-1.22). The lack of an overall effect occurred despite a net 11% lower-density lipoprotein cholesterol level and a 10% higher high-density lipoprotein cholesterol level in the hormone group compared with the placebo group (each P<.001). Within the overall null effect, there was a statistically significant time trend, with more CHD events in the hormone group than in the placebo group in year 1 and fewer in years 4 and 5. More women in the hormone group than in the placebo group experienced venous thromboembolic events (34 vs 12; RH, 2.89; 95%, 1.50-5.58) and gallbladder disease (84 vs 62; RH, 1.38; 95% CI, 1.00-1.92). There was no significant difference in several other end points for which power was limited, including fracture, cancer, and total mortality (131 vs 123 deaths; RH, 1.08; 95% CI, 0.84-1.38).
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