(Circulation. 1996;94:2699-2702.)
© 1996 American Heart Association, Inc.
Articles |
Estrogen Replacement
the Department of Medicine, University of Tennessee, Memphis.
Correspondence to Dr Jay Sullivan, Department of Medicine, University of Tennessee, 951 Court Ave, Room 353D, Memphis, TN 38163.
Key Words: Editorials • hormones • sex • women • cardiovascular diseases
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Introduction |
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As the system for financing and providing healthcare in the United States undergoes reform, increased emphasis is being placed on evidence-based medicine, that is, medical management based on the results of carefully designed, conducted, and analyzed, large-scale, multicenter, randomized, placebo-controlled clinical trials. This approach has the dual advantages of avoiding risk by not recommending courses of clinical therapy that are as yet unproven and avoiding cost by not paying for unproven therapy.
The practice of evidence-based medicine can be very comfortable. For example, because of the results of three multicenter trials of coronary bypass surgery, cardiologists can confidently recommend revascularization for symptomatic patients with hemodynamically significant lesions of the left main coronary artery. Unfortunately, one of the most difficult aspects of being a practicing physician is the frequent need to make decisions on the basis of incomplete data. This is the dilemma that faces physicians who follow the recommendation of the American College of Physicians that all postmenopausal women be considered for estrogen replacement therapy1 and the recommendation of the National Cholesterol Education Program Adult Treatment Panel II that postmenopausal women with hypercholesterolemia receive estrogen replacement.2 The results of large, randomized, controlled trials are not available.
What evidence supports this recommendation of the College of Physicians? Several recent reviews have addressed this issue.3 4 5 6 Thus, only the main points will be addressed here. Little controversy exists concerning the conclusion that bilateral oophorectomy results in an increased incidence and prevalence of coronary atherosclerosis. Over four decades ago, Wuerst and his coworkers7 reported
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Y. Matsubara, M. Murata, K. Kawano, T. Zama, N. Aoki, H. Yoshino, G. Watanabe, K. Ishikawa, and Y. Ikeda Genotype Distribution of Estrogen Receptor Polymorphisms in Men and Postmenopausal Women From Healthy and Coronary Populations and Its Relation to Serum Lipid Levels Arterioscler Thromb Vasc Biol, November 1, 1997; 17(11): 3006 - 3012. [Abstract] [Full Text]
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