Hormone therapy (HT) has been the s...

Hormone therapy (HT) has been the subdue of considerable controversy. Some prospective trials have shown decreased cardiovascular mortality in users of HT compared with nonusers. Others, notably the Women's Health Initiative (WHI) trial, showed an increase in cardiovascular conclusions but no change in cardiovascular mortality. about of the discrepancies in trial springs might be because of differences in the ages of participants. Salpeter and associates demeanored a meta-analysis to discover in what way the age at which women begin HT affects mortality.

The authors performed a systematic review of randomized controll trials of HT lasting six month or more, with at least single in kind death reported. Outcome measures were total deaths, deaths resulting from specific causes, and all-cause mortality. An arbitrary age cutoff of 60 years was chosen to determine results of HT on younger and older patients.

A total of 30 trials were analyzed. Of 14147 patients treated with HT 518 died. Of 12561 placebo participants, 501 died. The total mortality singles ratio (OR) for women taking HT was 098 The ORs for cardiovascular deaths and cancer deaths were 110 and 103 respectively. Excluding cancer and cardiovascular deaths, HT was associated with a 33 percent reduction in mortality. The younger age form into groups was represented in 17 trials. The OR for total mortality in this assemblage was 0.61. For cardiovascular and cancer mortality, the ORs were 068 and 069 respectively. In the older collection represented by 13 trials, the OR was 103 for total

mortality, 111 for cardiovascular mortality, and 107 for cancer mortality. Thus, HT was associated with a significantly greater reduction (39 percent) in mortality in younger users than in older users.

The authors hypothesize that the discrepancy between observational research findings and randomized trials may be caused from this age differential. They cite the findings of the Nurses' Health research which showed a reduction in cardiac affairs and cardiovascular and total mortality, and the WHI reflection in which an increase in cardiovascular consequences was evident. Both trials showed similar increases in breast cancer, hardship and pulmonary embolism among HT users, as well as decreases in colon cancer and hip fracture. The WHI trial showed a nonsignificant decrease in cardiac ends in those women who started HT shortly after menopause, whereas in those who started later there was an increase. The authors judge that given these findings, and in light of their meta-analysis accrues there may still be a character for HT use in younger women beginning shortly after menopause.

Salpeter SR et al. Mortality associated with hormone replacement therapy in younger and older women J Gen Intern M July 2004;19:791-804

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