Re: Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial
16 October 2012
We congratulate the authors of this study which has inspired similar questions as raised in other such studies. The hard end points of any such study are, deaths, cancers,myocardial infarction, and stroke.
Heart failure, coronary intervention and angina requiring hospitalization are open to bias. It is also important to do intention to treat analysis.In majority of the drug trials where study is supported by industry, such favours are expected by the financers of the study. Unfortunately, this study also appears to have same weakness, as other drug trials,unless the authors let us know the comparison of actual hard end points in the two groups (1,2). Secondly, we would like to know the biomarkers; brain natriuretic peptide in heart failure and HDL,LDL, lipoproteins (a)and inflammatory cytokines in the two groups. Oestrogens are known to decrease LDL and to increase HDL, but they also increase pro-inflammatory C-reactive protein, coagulation and lipoprotein(a), which are known for their adverse effects on atherothrombosis. It seems that vascular biological states appear to be most important determinant of atherothrombosis compared to circulating LDL, although most experts give greater importance to circulating LDL. In fact C-reactive protein has been found to be as predictive of subsequent coronary events as LDL on treatment with statins. The concentration of oxidized LDL, particularly in the vascular cells, depends on the internal antioxidant environment which is determined by dietary patterns and lifestyles. Therefore, we would urge the authors to recalculate the well accepted hard end points in the two groups which should include; Deaths, cancers, myocardial infarction and stroke because hospitalization for angina, heart failure and coronary intervention may be advised by the physician by his own discrition.We would gratefully appreciate the authors to let us know the results of suggested analysis.
1.Ridker PM, Danieison E, Fonseka FAH, Genest J, Gotto AM, Kastelein JJP, Koenig W, Libby P, Lor AJ, MacFadyen JG,Nordestgaard BG, Shepherd J, Willerson JT. Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet March 2009doi:10.1016/S0140-6736(09)60447-5
2.De Logeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors and the rate of cardiovascular complications after myocardial infarction. Final report of the Lyon Diet Heart Study. Circulation 1999;99:779–785.
Competing interests: None declared
President,The Tsim Tsoum Institute, Krakow, Poland
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