Re: Statement on Results of the HERS II Trial on Hormone Replacement Therapy by ACOG
From: art fougner, md (evsono@pipeline.com)
Thu Jul 4 08:42:31 2002
as the pendulum swings ...
art
At Thu, 4 Jul 2002, Efrain Ramirez wrote:
>
>ACOG NEWS RELEASE
>For Release July 2, 2002
>
>Statement on Results of the HERS II Trial on Hormone Replacement Therapy
>By The American College of Obstetricians and Gynecologists
>
>Results of the Heart and Estrogen/Progestin Replacement Study Follow-up
>(HERS II) appear in the July 3, 2002 issue of The Journal of the
>American Medical Association (JAMA).1 This study followed participants
>in the 4.1 year HERS I study 2 for an additional 2.7 years on average.
>
>Both HERS trials looked at the effect of a combination of hormone
>replacement therapy (0.625 mg of conjugated estrogens plus 2.5 mg
>medroxyprogesterone acetate daily) on coronary and non-coronary diseases
>in older, postmenopausal women with pre-existing coronary disease (CHD).
>
>HERS II trial results confirm the initial findings of HERS I: that
>hormones brought no overall reduction in risk of coronary events for
>this population of older women with CHD. Because HERS I showed an
>increased risk of coronary events in the early years of treatment
>followed by a reduced risk in subsequent years, some had hypothesized
>that a cardiovascular benefit would be seen with additional years of
>treatment. However, HERS II indicates that even with additional years
>of observation (for a total of 6.8 years of study on average), hormone
>treatment does not provide a cardiovascular benefit in older women with
>CHD - i.e., secondary prevention of heart disease. Study authors note
>this finding supports the position of the American Heart Association in
>not recommending HRT use in older women with CHD for the purpose of
>preventing coronary events.
>
>Whether HRT helps prevent heart disease in women who don't already have
>the disease (primary prevention) remains an open question. The HERS
>studies did not address whether postmenopausal hormones prevent CHD in
>younger, healthier women. HERS study participants had CHD and were 71
>years of age on average at the start of the HERS II study: the average
>age of US women at menopause, when they are most likely to initiate HRT,
>is 51. Answers on this issue will have to come from other research
>studies.
>
>Part II of the HERS II study examined the effects of hormone therapy on
>non-cardiovascular disease outcomes. Most findings confirmed previous
>observational studies or the results of HERS I. Hormone treatment
>slightly increases the risk of deep vein thrombosis and pulmonary
>embolism. The study's oral hormone treatment also showed a
>statistically significant increased risk of biliary tract (gallbladder
>disease) surgery for this older population.
>
>HERS II found that hip fractures were slightly more common in women on
>HRT, although the authors note this is probably a chance finding. Other
>retrospective studies have shown that HRT can stop declining bone
>density in women who have, or are at risk for, osteoporosis, when given
>within a few years of menopause and continued for some period of time.
>Since few of the women in the HERS study appeared to have osteoporosis,
>it is not surprising that estrogen treatment was not found to reduce
>bone fractures. Use of the study to justify abandoning HRT as a method
>of improving bone health is premature.
>
>Use of hormones did not appear to increase the risks of cancers. The
>6.8 year HERS study did not find a statistically significant increase in
>breast cancer. Some other studies have suggested that if HRT increases
>the risk of breast cancer it comes with long-term use (7 to 10 years or
>more). Since breast cancer is a major concern for many women, the HERS
>results could be reassuring for women considering HRT for short-term
>use.
>
>The combined HERS studies provide important information in our
>understanding of the effects of hormones on older women with CHD.
>Doctors and patients must still await the outcome of additional research
>for HRT effects in younger, healthier postmenopausal women. Finally, as
>the HERS authors point out, the use of HRT for relief of menopausal
>symptoms -- such as hot flashes or vaginal dryness -- continues to be a
>benefit for women in the perimenopause or early menopause years. For
>many women, HRT can provide significant symptom relief.
>
>For these reasons, ACOG continues to recommend that decisions regarding
>a woman's use of HRT when indicated be made between the woman and her
>physician on an individual basis. 3
>
>--------------------------------------------------------------------------------
>
>--------------------------------------------------------------------------------
>1 Heart and estrogen/progestin replacement study follow-up (HERS II):
>--------------------------------------------------------------------------------
>--------------------------------------------------------------------------------
>Part 1, Grady D et al, Cardiovascular outcomes during 6.8 years of
>--------------------------------------------------------------------------------
>
>--
>--------------------------------------------------------------------------------
>hormone therapy. Part II, Hully S et all, Non-cardiovascular outcomes
>--------------------------------------------------------------------------------
>during 6.8 years of hormone therapy.
>--------------------------------------------------------------------------------
>
>2 Hully S et al. Randomized trial of estrogen plus progestin for
>secondary prevention of coronary heart disease in postmenopausal women.
>JAMA. 1998; 280: 605-613.
>
>3 ACOG. Guidelines for Women's Health Care (Second Edition, 2002), at
>316.
>
># # #
>
>The American College of Obstetricians and Gynecologists (ACOG) is the
>national medical organization representing over 40,000 physicians who
>provide health care for women.
>
>--
>"Life is neither the notes nor the silence between the notes, but the music that
> arises out of sound and silence felt as a living whole. Stop choosing...between
> chaos and order, and live at the boundary between them, where rest and action
> move together..." David Whyte
>
--
art fougner, md
ich bin ein New Yorker
|
|
