This column reviews the recent history of research into the effect of hormone therapy on the risk of heart disease in women at and after menopause. It attempts to put into context both the observational studies of women who chose for themselves whether to take hormones (and to do or not do other things that can affect heart risks) as well as the Women's Health Initiative, which randomly assigned thousands of women to take hormones or an inactive placebo. It would have been even more useful if the differences in study designs had been more clearly outlined, however; the piece assumes that the reader knows the difference and why it matters.
However, if the focus was on giving women good information about their risk of heart disease, the piece falls short by failing to mention other proven ways to lower it: control of risk factors such as high blood pressure, high cholesterol, smoking, and overweight/obesity; and the use of medications to control risk in women who have diagnosed coronary disease. It's also not clear how women would know if they had a 'heavy dose of heart risk factors' and so should avoid hormone therapy: those risk factors are not noted.
Finally, the statement "This new analysis tells us that hormones have no or very little risk for women when started within 10 years of menopause" is not accurate. There IS an increased risk of breast cancer if combined hormone therapy is used for more than a few years.
There is no mention of the costs of hormone therapy.
The absolute difference in heart disease risk between women who took hormones and those who did not, and the differences among age groups, are not provided.
The article focuses on the associations between hormone use, heart disease, and the ages at which women begin using hormones. It does not mention other known harms of hormone use. For example, the statement, "This new analysis tells us that hormones have no or very little risk for women when started within 10 years of menopause" is not accurate; there IS an increased risk of breast cancer if used for more than a few years.
While the story states many times that heart benefits have been seen in observational studies of hormone therapy, it does not make clear that the unique contribution of the Women's Health Initiative is that it was a randomized trial, in which women did not choose whether they would be in the hormone group or the placebo group. The author assumes that the reader knows that WHI was a randomized trial and how that makes its findings different from those of the earlier observational trials.
There is no disease-mongering; heart disease is clearly a serious concern for women.
The writer notes her prior position as director of NIH, and cites the chief of the Women's Health Initiative branch of NIH.
There is no mention of other options for reducing coronary heart disease risk or of other treatments for menopausal symptoms, since no one is proposing that HRT be used for reducing coronary disease risk.
It's clear that hormone therapy is readily available and has been for many years.
Hormones are clearly not a novel therapy.
The story clearly relies both on a recent journal article as well as many years of clinical research.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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