on May 6, 2004
Published online before print May 6, 2004, doi: 10.1161/01.ATV.0000131262.98040.65
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Submitted on January 16, 2004
Accepted on April 18, 2004
Should Progestins Be Blamed for the Failure of Hormone Replacement Therapy to Reduce Cardiovascular Events in Randomized Controlled Trials?
Kwang Kon Koh * and Ichiro Sakuma
From the Department of Cardiology (K.K.K.), Gil Medical Center, Gachon Medical School, Incheon, Korea; and the Department of Cardiovascular Medicine (I.S.), Hokkaido University Graduate School of Medicine, Sapporo, Japan.
* To whom correspondence should be addressed. E-mail: kwangk{at}ghil.com.
Abstract--Many observational studies and experimental and animal studies have demonstrated that estrogen replacement therapy (ERT) or hormone replacement therapy (HRT) (estrogen plus progestin) significantly reduces the risk of coronary heart disease. Nonetheless, recent randomized controlled trials demonstrated some trends toward an increased risk of cardiovascular events rather than a reduction of risk. Recently, both the HRT and ERT arms of the Women’s Health Initiative (WHI) study were terminated early because of an increased/no incidence of invasive breast cancer, increased incidence of stroke, and increased trend/no protective effects of cardiovascular disease. We discuss the controversial effects of HRT and ERT on cardiovascular system and provide a hypothesis that the failure of HRT and ERT in reducing the risk of cardiovascular events in postmenopausal women might be because of the stage of their atherosclerosis at the time of initiation of HRT or ERT.
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