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  Is 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.


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