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15 July 1998 | Volume 129 Issue 2 | Pages 160-161
The recent paper by McNagny and colleagues [1] stimulates discussion about two issues related to the potential primary prevention of ischemic heart disease on a large-scale basis by use of hormone replacement therapy (HRT).
First, data on the personal characteristics of the U.S. women physicians who were using HRT indicate that these women were healthier than those who were not using HRT. Contrary to what one might expect, they were characterized by lower prevalences of high cholesterol levels and diabetes mellitus and by a personal or family history of a lower prevalence of coronary heart disease. We know that physicians' personal health practices affect their ways of counseling patients. The result might well support the hypothesis that the protective effect of HRT has been overestimated in studies done in U.S. women.
Second, from a public health perspective, the comment that higher rates of HRT use by women physicians may presage greater use of HRT by U.S. women in the future must be considered in the light of mortality trends for diseases relevant to HRT use (ischemic heart disease and breast cancer). We recently analyzed the observed and predicted mortality trends for ischemic heart disease and breast cancer in women 50 to 70 years of age in several countries, including the United States [2]. Currently, in the United States, mortality rates for ischemic heart disease are higher than those for breast cancer in this age range. In the future, however, the expected number of deaths from ischemic heart disease is likely to be much lower, and the two curves will get closer and may cross over by the first decade of the next century (Figure 1 on page 160). The picture provides some warning about the risk–benefit balance of HRT use on a large-scale basis for the primary prevention of ischemic heart disease. LETTER
Postmenopausal Hormone Replacement
TO THE EDITOR:
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References
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1. McNagny SE, Wenger NK, Frank E. Personal use of postmenopausal hormone replacement therapy by women physicians in the United States. Ann Intern Med. 1997; 127:1093-6.
2. Panico S, Galasso R, Celentano E, Ciardullo AV, Frova L, Capocaccia R, et al. Large-scale hormone replacement therapy and life expectancy: results from an international comparison among European and North American populations [Abstract]. Can J Cardiol. 1997; 13(Suppl B):187S.
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