BMJ 1994;309:808-809 (24 September)

Letters

Cardioprotective effect of hormone replacement therapy Is not due to a selection bias

EDITOR, - Ward F M Posthuma and colleagues have shown that many of the studies that report reductions in the risk of coronary disease among postmenopausal women using hormones also show decreases in cancer.1 They claim that this implausible result shows a selection bias toward healthier women for hormone treatment and that the benefits in terms of heart disease must be considered to be suspect. In the exchange of correspondence they do not address the substantive arguments raised by Stevenson and Baum but instead accuse them of showing "ignorance of common medical reasoning."2,3 Posthuma and colleagues, however, seem themselves to have ignored some common medical reasoning.

In their paper they talk about "total cancer within each study," but in many instances the studies were reporting the mortality from cancer rather than the incidence of cancer. This is an important distinction because, typically, patients who die of cancer have had the . . . [Full text of this article]


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Relevant Article

Cardioprotective effect of hormone replacement therapy in postmenopausal women: is the evidence biased?
W F M Potshuma, R G J Westendorp, and J P Vandenbroucke
BMJ 1994 308: 1268-1269. [Abstract] [Full Text]

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