IJE Advance Access originally published online on May 27, 2004
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International Journal of Epidemiology, Volume 33, Number 3, pp. 461-463
IJE vol.33 no.3 © International Epidemiological Association 2004; all rights reserved.
Commentary |
Commentary: Hormone replacement therapy and coronary heart disease: four lessons
Kaiser Permanente Southern California, 393 E Walnut Street, Pasadena, CA 91188, USA. E-mail: diana.b.petitti@kp.org
| The first 150 words of the full text of this article appear below. |
In 1991, Stampfer and Colditz,1 reviewing epidemiological studies of the effect of postmenopausal oestrogen on coronary heart disease concluded that: ‘... the bulk of evidence strongly supports a protective effect of estrogens that is unlikely to be explained by confounding factors ...’
Their best estimate of the relative risk of coronary heart disease (CHD) in postmenopausal oestrogen users was calculated using meta-analytical techniques applied to the epidemiological studies they deemed to be of high quality based on their designs—prospective studies with internal controls and angiographic studies. This estimate was 0.50. The CI was narrow –0.43 to 0.56.
The Stampfer and Colditz paper was cited widely. It became a shorthand citation for the contention that the ‘epidemiologic evidence showing that hormone replacement therapy prevents coronary heart disease is overwhelming.’
In 1998, the results of the first large randomized, placebo-controlled trial of the effect of combined oestrogen/progestin hormone replacement therapy on coronary
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Lesson one: do not turn a blind eye to contradiction |
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Lesson two: do not be seduced by mechanism |
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Lesson three: suspend belief |
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Lesson four: maintain scepticism |
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