Individualizing the risks and benefits of postmenopausal hormone therapy
Individualizing the risks and benefits of postmenopausal hormone therapy
Objective: The objective was to develop an individualized risk-benefit model quantifying the impact of combined use of estrogen and progestogen on chronic diseases.
Design: The study population consisted of women, aged 40+, prescribed postmenopausal hormone therapy (HT) in the UK General Practice Research Database (N > 200,000). Individualized risks of fracture, colorectal cancer, diabetes mellitus, myocardial infarction, deep venous thrombosis/pulmonary embolism, breast cancer, and stroke were estimated using Cox regression. Relative rates from the Women's Health Initiative trial were used to estimate attributable risks (ie, excess risks) in a risk-benefit simulation model.
Results: Risks and benefits increased with age and length of HT use. HT use for 5 years initiated at age 45 increased the absolute risk of myocardial infarction by 0.04% and breast cancer by 0.3% and reduced the risk of hip fracture by 0.03%. Comparably, 5-year HT use started at age 75 led to increases in the risks of myocardial infarction and breast cancer (+0.4% and +0.2%, respectively) and reduced that of hip fracture (-0.9%). There was considerable heterogeneity in the risks and benefits of HT. In most of the younger HT users, the frequency of risks exceeded that of the benefits, although the absolute excess risks were small. In HT users aged 70+, 62.4% experienced more benefits than risks, whereas 37.6% experienced more risks than benefits.
Conclusions: The frequency of beneficial and adverse effects of HT on chronic diseases was low in younger women, whereas the ratio of these risks and benefits varied substantially among the older users. However, the study could not asses the effects of HT on menopausal symptoms and quality of life, benefits more likely to be observed among younger women.
stroke, bone, hip, chronic disease, breast cancer, adverse effects, cancer, quality of life, research, risk, diabetes, embolism, aged, myocardial infarction, health, women, diabetes mellitus, therapy, disease
374-381
van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Barlow, David
604bd0b9-bc34-49d8-9f29-e2637adbd922
Leufkens, Hubert G.M.
299d1b54-3a02-48a9-9ffb-71ba2c3fa469
March 2008
van Staa, Tjeerd P.
3e33e405-5ea6-4196-9693-7258f7fba8cb
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Barlow, David
604bd0b9-bc34-49d8-9f29-e2637adbd922
Leufkens, Hubert G.M.
299d1b54-3a02-48a9-9ffb-71ba2c3fa469
van Staa, Tjeerd P., Cooper, Cyrus, Barlow, David and Leufkens, Hubert G.M.
(2008)
Individualizing the risks and benefits of postmenopausal hormone therapy.
Menopause, 15 (2), .
(doi:10.1097/gme.0b013e31812e558f).
Abstract
Objective: The objective was to develop an individualized risk-benefit model quantifying the impact of combined use of estrogen and progestogen on chronic diseases.
Design: The study population consisted of women, aged 40+, prescribed postmenopausal hormone therapy (HT) in the UK General Practice Research Database (N > 200,000). Individualized risks of fracture, colorectal cancer, diabetes mellitus, myocardial infarction, deep venous thrombosis/pulmonary embolism, breast cancer, and stroke were estimated using Cox regression. Relative rates from the Women's Health Initiative trial were used to estimate attributable risks (ie, excess risks) in a risk-benefit simulation model.
Results: Risks and benefits increased with age and length of HT use. HT use for 5 years initiated at age 45 increased the absolute risk of myocardial infarction by 0.04% and breast cancer by 0.3% and reduced the risk of hip fracture by 0.03%. Comparably, 5-year HT use started at age 75 led to increases in the risks of myocardial infarction and breast cancer (+0.4% and +0.2%, respectively) and reduced that of hip fracture (-0.9%). There was considerable heterogeneity in the risks and benefits of HT. In most of the younger HT users, the frequency of risks exceeded that of the benefits, although the absolute excess risks were small. In HT users aged 70+, 62.4% experienced more benefits than risks, whereas 37.6% experienced more risks than benefits.
Conclusions: The frequency of beneficial and adverse effects of HT on chronic diseases was low in younger women, whereas the ratio of these risks and benefits varied substantially among the older users. However, the study could not asses the effects of HT on menopausal symptoms and quality of life, benefits more likely to be observed among younger women.
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Published date: March 2008
Keywords:
stroke, bone, hip, chronic disease, breast cancer, adverse effects, cancer, quality of life, research, risk, diabetes, embolism, aged, myocardial infarction, health, women, diabetes mellitus, therapy, disease
Identifiers
Local EPrints ID: 61580
URI: http://eprints.soton.ac.uk/id/eprint/61580
ISSN: 1072-3714
PURE UUID: e21e9dbb-1df4-460f-b42b-3288fa3de9ce
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Date deposited: 10 Oct 2008
Last modified: 18 Mar 2024 02:44
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Contributors
Author:
Tjeerd P. van Staa
Author:
David Barlow
Author:
Hubert G.M. Leufkens
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