Letters HRT and cardiovascular events

The age hypothesis does not stand up to scrutiny

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8149 (Published 03 December 2012) Cite this as: BMJ 2012;345:e8149
  1. Klim McPherson, visiting professor of public health epidemiology1
  1. 1New College, Oxford OX1 3BN, UK
  1. klim.mcpherson{at}new.ox.ac.uk

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—that women in the Women’s Health Initiative who were well past the menopause responded differently from symptomatic menopausal women with respect to cardiovascular risk.

All such arguments ignore the double blind placebo controlled studies of such symptomatic women. A synthesis of such studies (including unpublished ones—a process resisted by the manufacturers) was published in the BMJ and the Lancet and later summarised in the BMJ.2 3 4 Evidence from a synthesis of some 200 efficacy studies submitted for licensing of hormone therapy products strongly suggests that the risk is the same in both sets of women. Purveyors of the age hypothesis need to take on board all of the evidence, especially from well controlled randomised controlled trials.


Cite this as: BMJ 2012;345:e8149


  • Competing interests: None declared.