| Titre : | Hormones and heart disease in women : The timing hypothesis. Commentary. (2007) |
| Auteurs : | BARRETT-CONNOR (Elizabeth) / disc. : USA. Division of Epidemiology. Department of Family and Preventive Medicine. School of Medicine. University of California. San Diego. CA. ; Shari-S BASSUK ; MANSON (Joann-E) : USA. Department of Epidemiology. Harvard School of Public Health. Boston. MA. |
| Type de document : | Article |
| Dans : | American journal of epidemiology (vol. 166, n° 5, 2007) |
| Pagination : | 506-517 |
| Langues: | Anglais |
| Mots-clés : | Cardiopathie coronaire ; Complication ; Coeur ; Femme ; Homme ; Produit substitution ; Recommandation ; Ménopause ; Appareil cardiovasculaire ; Appareil circulatoire [pathologie] |
| Résumé : | [BDSP. Notice produite par INIST-CNRS 5L2bR0xD. Diffusion soumise à autorisation]. Largely on the basis of results from meta-analyses of observational studies, postmenopausal estrogen was widely prescribed to prevent coronary heart disease. However, epidemiologic studies, no matter how consistent and coherent, are not sufficient to recommend mass preventive therapy to healthy women. In fact, all three large clinical trials failed to confirm estrogen's expected cardiac protection. The most persistent explanatory hypothesis for the "trial failure" was the age of the participants, based on the thesis that estrogen in recently menopausal women could prevent the development of coronary artery plaque but, given to older women with vulnerable plaque, would have a null or even harmful effect. The timing hypothesis is plausible, but the prespecified subgroup analyses in both Women's Health Initiative trials showed no significant interaction with age or years since menopause. The best opportunity to test the timing hypothesis was lost when 1,000 Women's Health Initiative women younger than 60 years had coronary artery calcium scans to evaluate the effect of estrogen on plaque burden, but no women 60 years or over were similarly examined. Therefore, this ancillary study can examine the effect of estrogen treatment on coronary calcium in women younger than 60 years but will not be able to determine if the effect is different in older women. In the meantime, publicized statements in multiple venues have promoted the timing hypothesis as fact, confusing patients and physicians who do not realize that the hypothesis is stronger than the evidence. After the initial report from the Women's Health Initiative estrogen-progestin trial, which found that menopausal hormone therapy was associated with an increased risk of coronary heart disease in the overall cohort (age range : 50-79 years ; mean age : 63 years), researchers took a closer look at the data from this and other studies, focusing on the timing of initiation of such therapy. The results suggest that hormone therapy may have a beneficial effect on the heart if started in early menopause, when a woman's arteries are still likely to be relatively healthy, but a harmful effect if started in late menopause, when advanced atherosclerosis may be present. The implication of the timing hypothesis for clinical practice is not that recently menopausal women be given hormone therapy for coronary heart disease prevention but rather that clinicians can be reassured about cardiac risks when considering short-term use of hormone therapy for vasomotor symptom relief in such women. The reduction in vasomotor symptoms must be weighed against other risks and benefits of treatment, but coronary disease is typically not a major factor in the equation for women who are recently menopausal. |
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