Schierbeck and colleagues suggested that “initiation of hormone replacement therapy in women early after menopause significantly reduces the risk of the combined endpoint of mortality, myocardial infarction, or heart failure” [1]. They invoke the age hypothesis, which remains one of the abiding critiques of the WHI study, namely that women well past the menopause in WHI responded differently to exogenous hormones than do symptomatic menopausal women, with respect to cardiovascular risk.

All such arguments have perforce to ignore the only double blind placebo controlled studies of such symptomatic women, a synthesis of which was published in the BMJ [2] and then the Lancet [3] including unpublished studies (a process resisted by the manufacturers) and summarised in the BMJ [4]. The evidence from a synthesis of some 200-efficacy studies submitted for licensing of HRT products strongly suggests that the risk is the same as found among older women in WHI as among younger women with menopausal symptoms. Purveyors of the age hypothesis need to take on board all of the evidence, especially from well-controlled RCT’s.

Yours,
Klim McPherson
New College
Oxford OX1 3BN

References

1. Schierbeck LL, Rejnmark L, Tofteng CL, Stilgren L, Eiken P, Mosekilde L, Køber L, Jensen JE. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ 2012; 345: e6409.

2. Hemminki E, McPherson K. Impact of postmenopausal hormone therapy on cardiovascular events and cancer: Pooled data from clinical trials. BMJ; 1997; 315:149-153.

3. Hemminki, E, McPherson K. The value of drug-licensing documents in studying the effect of postmenopausal hormone therapy on cardiovascular disease. Lancet, 2000; 355: 566 – 8

4. McPherson K, Hemminki E. Synthesising licensing data to assess drug safety. BMJ, Feb 2004; 328: 518-520

Competing interests: None declared