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Re: ERT/HRT- personal prescribing trendFrom: Jay Kulkin (jkulkin@mindspring.com)Fri Oct 18 21:37:40 2002
I'm not aware of HS-CRP as being "clearly" a cv risk factor thougn we do measure it in advanced lipid profiles looking at HDL and LDL subfractions. It is an inflammatory marker. I don't think the data clearly demonstrates this is a risk factor, though some do subscribe to the theroy that it is, as we don't really know where it is coming from. In fact tx for elevated CRP is ASA which one should take anyway. One additional finding in further dicing of the WHI data......LP (a) also reduced in the HRT group...may be protective but I think much of this needs more work on endpoint impact especially in view of the WHI report. JK Jay M. Kulkin MD MBA FACOG Women's Institute For Health PC 975 Johnson Ferry Road Suite 460 Atlanta, GA. 30342 ph: 404-832-0300 fax: 404-832-0070 http://www.wifh.com
> ----- Original Message ----- Zach, Please read the followup paper in JAMA two weeks later that revisited the WHI data set. In that paper, they noted that if the study group and control groups were controlled for CRP, a known cardiovascular risk factor, there was no longer an increased risk in the estrogen treatment group. This means that perhaps we need to consider CRP, homocysteine, And maybe Factor V Leiden if there is increased stroke risk. Overall, the WHI did show lower mortality. Less colon cancer. And, the issue of breast cancer mortality was not addressed, just the increased of new cases during a brief period of the study. Mark Perloe At 08:41 PM 10/16/2002 -0500, you wrote: The noise level in the role of use of ERT/HRT exceeds the specs on commercial grade ear protectors. The signal level has become garbage on the screen. Take any EBM you like, then place your bet. One thing rings true: it makes sense to assess and recommend on basis of individual risk/benefit analysis. Actually, that truism is meaningless, as there is no standard for such assessment. I digress to common sense and some science. Bad things happen to those who hold bad cards more often then to those who hold good cards. The baggage carried by bad card holders should not burden potential benefit to the good card holders. Life is not fair. The patient population in the pre,peri,post menopausal age group that I see are on average in generally good health. Heavy duty morbidity is certainly represented, but lightly on a numbers basis. Big morbidity translates into premature death risk. Other than vasomoter instability, where is there indication for long term ERT/HRT here? For the vigorously healthy, I passionately recommend ERT/HRT, absent a medical reason or patient objection. Trend mentioned in subject line is toward increased use of transdermal delivery in the belief that avoidance of first hepatic passage could reduce multiple risk concerns fostered by induction of hepatic enzyme systems with oral route. Zach Newton Z. B. Newton, III, M.D. Atlanta/Gyn
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