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PRIMARY CARE: E Løkkegaard, A T Pedersen, B L Heitmann, Z Jovanovic, N Keiding, Y A Hundrup, E B Obel, and B Ottesen Relation between hormone replacement therapy and ischaemic heart disease in women: prospective observational study BMJ 2003; 326: 426 [Abstract] [Full text]

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Bed-Side recognizing the “real risk” of CAD before prescribing HRT.

Sergio Stagnaro   (21 February 2003)

HRT harmful or selection of HRT?

Richard D Jenkins   (21 February 2003)

Bed-Side recognizing the “real risk” of CAD before prescribing HRT. 21 February 2003
Sergio Stagnaro, Specialist in Blood, Gastrointestinal, and Metabolic Diseases. Researcher in Biophysical Semeiotics. Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genoa) Italy Send response to journal: Re: Bed-Side recognizing the “real risk” of CAD before prescribing HRT.	Sirs, In day-to-day practice, also hormone replacement therapy is prescribed to a “single” and “unique” patient, who can either present, or not, the”real risk” of CAD (1)(See my contribution in Medscape: http://boards.medscape.com/forums?50@246.8SdzaDocb0q^8@.eea5d38 as well as my below-cited site), apart from her glucose and, particularly, lipid metabolism, according to the great Josslin: lipid deposit in skeletal muscle, myocardial, hepatic, a.s.o., cells, precedes for years or decades type 2 DM onset, as I have demonstrated with the aid of Biophysical Semeiotics (See HONCode site 233736, http://digilander.libero.it/semeioticabiofisica , Practical Application, Diabetes, three articles). As a matter of fact, notoriously, a subgroup of women do not benefit from hormone replacement treatment, as regards ischaemic heart disease prevention. Certainly, women with diabetes who use hormone replacement therapy are at an increased risk of death from all causes and ischaemic heart disease and are affected by such and are at “real risk” of CAD: consequently, doctors must learn, firstly, in order to select properly the women who can undergo successfully to HRT. 1) Stagnaro-Neri M., Stagnaro S., Deterministic Chaos, Preconditioning and Myocardial Oxygenation evaluated clinically with the aid of Biophysical Semeiotics in the Diagnosis of ischaemic Heart Disease even silent. Acta Med. Medit. 13, 109, 1997. 1) Competing interests:   None declared
HRT harmful or selection of HRT? 21 February 2003
Richard D Jenkins, Consultant Physician Princess of Wales Hospital, Bro-Morgannwg NHS Trust, Bridgend. CF34 Send response to journal: Re: HRT harmful or selection of HRT?	Although Dr Ellen Løkkegaard and colleagues point out the potential bias in their observational study from the Danish nurses selecting to be treated with Hormone Replacement Therapy (HRT) or their doctors selecting the treatment for them I feel they have not addressed this as an alternative explanation of their findings in their discussion. HRT may have a neutral effect on the risk of Ischaemic Heart Disease which their study supports. However, the decision to be treated with HRT prior to the questionnaire in 1993 may reflect differences in the patients' and their doctors' personalities which could also influence their diabetic or blood pressure control. It may be this difference that explains the increased risk of death and not the HRT itself. It would be useful to look at any data they may have on health seeking behaviour and attitudes to disease in this cohort of Danish nurses. Competing interests:   None declared