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Update in General Internal Medicine
- John V.L. Sheffield, MD; and
- Eric B. Larson, MD, MPH
- From Harborview Medical Center and Group Health Cooperative, Seattle, Washington.
2003–2004 Series: Update Sessions from ACP's 2003 Annual Session
This Update in General Internal Medicine incorporates a diverse range of topics that includes hormone replacement therapy, statins, exercise, hypertension, prostate cancer, diabetes care, and antioxidant vitamins. We compiled these articles with the help of our colleagues in the Department of Medicine at the University of Washington, Seattle, Washington, and the editors of ACP Journal Club.
Hormone Replacement Therapy
The big news in women's health in 2002 came from the Women's Health Initiative (WHI) report, which found that combined hormone replacement therapy (HRT) (estrogen plus progestin) exposes postmenopausal women to more risk than benefit. Before this report, most observational studies showed that HRT decreased risk for heart disease by as much as 35%. In retrospect, however, many of these studies did not control adequately for possible confounders, especially those related to major coronary risk factors and socioeconomic factors (1).
Combined Estrogen plus Progestin Replacement Therapy Increased Risk for Heart Disease and Breast Cancer among Postmenopausal Women with Intact Uteruses
The WHI recruited 16 608 healthy women who had intact uteruses and were 50 to 79 years of age (mean age, 63.3 years) from 40 U.S. clinical centers. Eighty-four percent of the women were white. The researchers conducted a randomized trial to determine the effects of HRT with combined estrogen plus progestin. Participants were randomly assigned to receive 0.625 mg of conjugated equine estrogens per day plus 2.5 mg of medroxyprogesterone per day in a single pill or placebo. Incident coronary disease and invasive breast cancer were primary outcomes. A global index summarizing risks and benefits for stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, and total mortality was a secondary outcome measure.
On the recommendation of the data and safety monitoring board, the trial was stopped after an average follow-up of 5.2 years because the risk for invasive breast cancer in the combined HRT group exceeded the predetermined termination threshold. (The …
