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(Circulation. 2007;115:820-822.)
© 2007 American Heart Association, Inc.

Editorial

Are Some Types of Hormone Therapy Safer Than Others?

Lessons From the Estrogen and Thromboembolism Risk Study

Kathryn M. Rexrode, MD, MPH; JoAnn E. Manson, MD, DrPH

From the Division of Preventive Medicine (K.M.R., J.E.M.), Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston Mass; and Department of Epidemiology (J.E.M.), Harvard School of Public Health, Boston, Mass.

Correspondence to Kathryn M. Rexrode, MD, MPH, 900 Commonwealth Ave, 3rd Floor, Boston, MA 02215. E-mail krexrode@partners.org.

Key Words: Editorials • hormones • women • venous thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Despite great strides in hormone therapy (HT) research, clinical trial data on the benefit-to-risk profile of different formulations, doses, and routes administration of HT remain lacking. Most of the large-scale clinical trials^1–3 have tested oral conjugated equine estrogens with or without medroxyprogesterone acetate, and data on nonoral routes and different types and doses of estrogens and progestogens have been limited. The evidence is mounting that route of delivery and possibly type and dose of HT are important factors, particularly for venous thromboembolism (VTE). Results of clinical trials^4,5 and observational studies⁶ have been concordant in demonstrating an increased risk of VTE with oral exogenous HT. Recent studies suggest that VTE risk may be lower with transdermal than oral estrogen⁷ and with estrogen alone than with combined therapy.⁴ However, in the absence of rigorous evidence from large-scale clinical trials on differential effects by hormone formulation or route of delivery, should these findings influence clinical practice?

Article p 840

The Estrogen and Thromboembolism Risk (ESTHER) study,⁷ published in the current issue of Circulation, adds important, relevant data to bolster the case that HT type and route of delivery do indeed make a difference. This well-designed, French, multicenter case-control study of VTE enrolled 271 consecutive cases of VTE in women (age, 45 to 70 years) and matched them to hospital and community controls. Current HT use was present in 46% of the VTE cases compared with 37% of controls. Oral HT users had 4-fold-increased odds of VTE; however, there was no increased risk . . . [Full Text of this Article]

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