the WHI data of any value in clinical practice?
The WHI data, the subject of press conferences before publication,
led to 30% of women in Europe and the USA stopping HRT because
of the fear of breast cancer, heart attacks and strokes.
More careful analysis of the several WHI publications reveals
the inappropriate design of the study and justifies more
optimistic conclusions. It was planned as primary prevention
study of healthy post menopausal receiving appropriate estrogen
therapy. But the patients were over weight, hypertensive,
and 8% with previous CVD aged 50-79.
The average age was 65 with
22% starting HRT, a mixture of 0.625 mg premarin and 2.5mg
MPA Although premarin ,with its unwanted effects on triglycerides,
is most frequently used in the USA the preference worldwide
is for oral or transdermal estradiol in the appropriate
dose for the indication and the age and health of the patient.
The dose and route is different
for climacteric depression than for vasomotor symptoms or
for osteoporosis in older women. One dose does not fit all.
This ill conceived study used the wrong patients of the
wrong age, used the wrong dose of the wrong hormone and
came to the wrong conclusions. Their conclusions were equivalent
to the view that "appendicectomy is inappropriate treatment
for gall bladder disease" We agree!
Further examination of the studies show that the increase
in heart attacks occurred only in the patients over 70.Patients
who started estrogens only (in the estrogen only arm of
the WHI study) aged 50-59 had a 48% decease in heart attacks
and a 32% decease in breast cancer and no increase in strokes.