Noncardiovascular Disease Outcomes During 6.8 Years of Hormone Therapy: Heart and Estrogen/Progestin Replacement Study Follow-Up (HERS II)

Hulley, Stephen B.; Furberg, Curt D.; Barrett‐Connor, Elizabeth; Cauley, Jane A.; Grady, Deborah; Haskell, William L.; Knopp, Robert H.; Lowery, Maureen H.; Satterfield, Suzanne; Schrott, Helmut G.; Vittinghoff, Eric; Hunninghake, Donald B.

doi:10.1097/00006254-200210000-00021

Cited by 202 publications

(259 citation statements)

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“…]. The results are consistent with the (non-significant) 27% increase found in the Heart and Estrogen Replacement Study II in postmenopausal women with coronary disease [15] and estimates from numerous observational studies suggesting an increased risk, especially of current longterm use (45 years).…”

Section: Hormone Replacement Therapysupporting

confidence: 88%

Risk factors and risk reduction of breast and ovarian cancer

Brekelmans

2003

Current Opinion in Obstetrics and Gynecology

114

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Purpose of review Breast and ovarian cancer remain a significant burden for women living in the Western world. This paper reviews the risk factors and current strategies to prevent these diseases. Recent findingsEstablished factors associated with the risk of breast cancer include family history, reproductive factors and lactation, as well as age at menarche and menopause. Hormone replacement therapy increases the risk, whereas oral contraceptives probably confer no increased risk. Alcohol moderately increases the risk, whereas a diet rich in folate and carotenoids might be protective. The role of other dietary factors, smoking and physical exercise remain unclear. Important risk factors for ovarian cancer are reproductive factors and possibly the longterm use of hormone replacement therapy. The risk is decreased by oral contraceptives. In carriers of a BRCA1 or BRCA2 gene mutation, prophylactic surgery can significantly reduce the risk of breast as well as ovarian cancer. Tamoxifen may be considered as a chemopreventive agent in women with a high risk of breast cancer, including carriers of a BRCA2 mutation, but is probably not effective in BRCA1 carriers. Summary During the period of this review, the importance of several known risk factors was confirmed, whereas the effects of other factors became more clear. Chemoprevention and prophylactic surgery have emerged as preventative options that can reduce the risk of breast and ovarian cancer.

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Section: Hormone Replacement Therapysupporting

confidence: 88%

Risk factors and risk reduction of breast and ovarian cancer

Brekelmans

2003

Current Opinion in Obstetrics and Gynecology

114

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“…Since estrogen replacement therapy (ERT) reduces LDL cholesterol (Whitcroft et al, 1994), and improves endothelium-dependent vascular reactivity (Lieberman et al, 1994), it was proposed that ERT could reduce the CHD risk. Never-theless, a large interventional study of estrogen therapy in secondary prevention of CHD not only failed to show benefits, but also demonstrated an increment in thromboembolic complications (Hulley et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Isolated soy protein improves endothelial function in postmenopausal hypercholesterolemic women

et al. 2003

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Background: Postmenopausia and hypercholesterolemia are related to endothelial dysfunction, a pathogenic event in atherosclerosis. Soy protein reduces plasma cholesterol, but there is scanty information about its effect on endothelial function. Objective: To evaluate the effect of isolated soy protein compared to caseinate on plasma lipoproteins and endothelial function in postmenopausal hypercholesterolemic women. Design: Randomized, double-blind, cross-over trial. Setting: Outpatient clinic of the Catholic University of Chile. Subjects: Eighteen healthy, postmenopausal women with hypercholesterolemia were recruited, included and completed the protocol. Interventions: During the trial, all patients followed a low fat/low cholesterol diet and were randomly assigned to receive isolated soy protein or matching caseinate for 4 weeks, and then the alternative treatment until week 8. At pre-study and at the end of the first and second period, plasma lipoprotein levels and endothelial function (flow-mediated dilatation (FMD) of the brachial artery) were evaluated. Results: Plasma total and low density lipoprotein (LDL)-cholesterol concentration were significantly lower with the low fat/low cholesterol diet compared to pre-study, either with caseinate or soy protein. No significant differences in plasma lipid concentration between caseinate or soy protein interventions were observed. FMD did not change with the caseinate. In contrast, when soy protein was administered, FMD was significantly higher compared to pre-study (9.471.8% vs 5.371.2%; Po0.05) and compared to caseinate intervention (9.471.8% vs 4.971.5%; Po0.033). Conclusions: These results suggest that in postmenopausal hypercholesterolemic women, soy protein improves endothelial function, regardless of changes in plasma lipoproteins. Sponsorship: Pontificia Universidad Cató lica (DIPUC99/09E), Protein Technology International and Gynopharm Laboratory (Recalcine Group).

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“…2 At the same time, another randomized trial with subsequent open-label observation of HRT treatment and follow-up, the Heart and Estrogen/ Progestin Replacement Study 2 (HERS2), reported on noncardiovascular outcomes, which for breast cancer represented an increased relative risk of 27%, although not statistically significant. 3 In the following discussions worldwide, it has been pointed out that the results from these 2 randomized studies may not apply to European women, as the HRT compounds preferred in the United States and Europe are different. The latest evidence comes from the Million Women's Study in the United Kingdom, and results confirm an increased risk of breast cancer following the current use of HRT, with the highest risk following the use of combined estrogen/progesterone regimens.…”

mentioning

confidence: 99%