Hormone Therapy May Lower Mortality in Younger Women - Researchers suggest also taking into account the benefits, harms of therapy in patient management

Hormone Therapy May Lower Mortality in Younger Women - Researchers suggest also taking into account the benefits, harms of therapy in patient management - Modern Medicine

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HOT TOPICS: Cardiometabolic Disorders & Weight · Liability & Risk Management· Health Care IT

The researchers found that there were 156 deaths (1.80 percent) in 8,689 women in the HRT group and 211 deaths (2.64 percent) in 7,594 women in the no-treatment group. The mortality relative risk was 0.73. When the researchers added data from eight observational studies (which followed 200,000 women) to their analysis, the relative risk was 0.72. The researchers determined that the posterior probability that HRT decreased mortality in younger postmenopausal women was nearly one.

"The synthesis of data using Bayesian meta-analysis indicates a reduction in mortality in younger postmenopausal women taking hormone therapy compared with no treatment," the authors conclude. "This finding should be interpreted taking into account the potential benefits and harms of hormone therapy."

One author reported consulting relationships with law firms representing Wyeth Pharmaceuticals on issues involving HRT, and another author reported a consulting relationship with GlaxoSmithKline.

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Comments from our Readers

mermaida / SAN FRANCISCO, CA, UNITED STATES
Posted 2009-11-09 10:15:44.0
The conclusions of these kinds of studies are very problematic and need to be evaluated carefully. Let's swap heart attacks or fractures for strokes or breast cancers in younger women. Please note we are very good at cracking the chest and fixing the heart. We are not very good at strokes. Breast cancer does not increase early mortality. But it does render women uninsurable and they have to keep looking over their shoulders for the rest of their lives. It is not a minor disease. And for events that are very rare under the age of 60 (VTE, PE, CVD, stroke), statistical significance can hang on one event plus or minus. These kinds of meta analyses are only as good as the studies they cite. Taking prior publications with bias and rehashing them in a meta analysis, serves to stack the deck, creating a form of publication bias. This repeated use of the same data has the effect of amplifying the impact of that data. Note also that industry directly and indirectly has been funding publications to slide, dice, and discredit the WHI. The lead author's disclosure has been noted in the posting. Working with industry does not necessarily disqualify a person from writing papers, but it does reveal a bias favorable to HT, and suggests that the underlying intent of this work from its inception was to "prove" that HT is safe in younger women. HT is relatively safe, but are the trade offs acceptable? The continued enthusiasm for HT and the efforts to reassure us that hormones are safe just softens the motivation and pressure to develop new menopausal treatments that do not confer serious risks like stroke and breast cancer.