Faculty Opinions recommendation of Conjugated equine estrogens and coronary heart disease: the Women's Health Initiative.

Publisher Website
Google Scholar
Abstract
This final report of the conjugated equine estrogen (CEE) only arm of the WHI trial, which includes final, centrally adjudicated results for the primary efficacy outcome (myocardial infarction or coronary death), as well as secondary outcomes and subgroup analyses, provides a suggestion of lower coronary heart disease risk (numerically fewer coronary events and coronary revascularization procedures) among women randomized to estrogen who were 50-59 years of age at baseline, holding open the possibility that menopausal estrogen therapy begun in the perimenopausal or early menopausal period may be useful in preventing coronary events. A limitation of this WHI trial is that the coronary event rate among women in their early 50s was only 0.21% per year, thus limiting the statistical power of the study to demonstrate differences in risk of myocardial infarction or coronary death by age group between estrogen-treated and placebo-treated women. The investigators calculated that the sample size required to detect the 30% treatment effect observed in the 50-54 year age group in the trial with 80% power would be in excess of 17,000. Therefore, the question of the relationship between time since menopause and coronary risk with CEE treatment remains open and will depend on the results of ongoing studies in which perimenopausal women are studied specifically. These important new analyses give additional support to the concept that the effects of menopausal estrogen on vascular health are in part age-dependent. As acknowledged by the authors, 'the views of both the medical and the lay communities regarding the role of exogenous estrogen during and after menopause remain in evolution during the current paradigm shift.

This publication has 0 references indexed in Scilit: