IJE Advance Access published online on May 27, 2004
International Journal of Epidemiology, doi:10.1093/ije/dyh125
© 2004 by International Epidemiological Association
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1 The Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
Considerable epidemiological evidence has accumulated regarding the effect of post-menopausal estrogens on coronary heart disease risk. Five hospital-based case-control studies yielded inconsistent but generally null results; however, these are difficult to interpret due to the problems in selecting appropriate controls. Six population-based case-control studies found decreased relative risks among estrogen users, though only 1 was statistically significant. Three cross-sectional studies of women with or without stenosis on coronary angiography each showed markedly less atherosclerosis among estrogen users. Of 16 prospective studies, 15 found decreased relative risks, in most instances, statistically significant. The Framingham study alone observed an elevated risk, which was not statistically significant when angina was omitted. A reanalysis of the data showed a nonsignificant protective effect among younger women and a nonsignificant increase in risk among older women. Overall, the bulk of the evidence strongly supports a protective effect of estrogens that is unlikely to be explained by confounding factors. This benefit is consistent with the effect of estrogens on lipoprotein subfractions (decreasing low-density lipoprotein levels and elevating high-density lipoprotein levels). A quantitative overview of all studies taken together yielded a relative risk of 0.56 (95% confidence interval 0.50-0.61), and taking only the internally controlled perspective and angiographic studies, the relative risk was 0.50 (95% confidence interval 0.43-0.56). 1Supported by Research Grants CA 40395 and HL 35464 from the National Institutes of Health. 2Presented at the Workshop on Antiestrogen Prevention of Breast Cancer, October 2-3, 1989, Madison, WI. Proceedings cosponsored by the National Cancer Institute (Grant 1 R13 CA49561-01) and the American Cancer Society (Grant RD 291).
Accepted July 19, 1990
Reprints and reflections
Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence
2 The Channing Laboratory, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; Technology Assessment Group, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
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