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Prior and current health characteristics of postmenopausal estrogen replacement therapy users compared with nonusers

  • Carol A. Derby
    Correspondence
    Reprint requests: Carol A. Derby, PhD, Pawtucket Heart Health Program, Memorial Hospital of Rhode Island, 111 Brewster St., Pawtucket, RI 02860.
    Affiliations
    Division of Health Education, Memorial Hospital of Rhode Island, Kingston, Rhode Island, USA

    Department of Community Health, Brown University School of Medicine, Pawtucket, Providence, USA
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  • Anne Lamont Hune
    Affiliations
    Department of Family Medicine, Memorial Hospital of Rhode Island, Kingston, Rhode Island, USA

    Family Medicine, Brown University School of Medicine, Pawtucket, Providence, USA

    Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
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  • Janice B. McPhillips
    Affiliations
    Division of Health Education, Memorial Hospital of Rhode Island, Kingston, Rhode Island, USA
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  • Marilyn McFarland Barbour
    Affiliations
    Department of Family Medicine, Memorial Hospital of Rhode Island, Kingston, Rhode Island, USA

    Department of Medicine, Brown University School of Medicine, Pawtucket, Providence, USA

    Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
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  • Richard A. Carleton
    Affiliations
    Division of Health Education, Memorial Hospital of Rhode Island, Kingston, Rhode Island, USA

    Department of Family Medicine, Memorial Hospital of Rhode Island, Kingston, Rhode Island, USA

    Department of Medicine, Brown University School of Medicine, Pawtucket, Providence, USA
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      Abstract

      OBJECTIVE: Our purpose was to investigate whether selection of healthy women for postmenopausal estrogen therapy may confound observational studies of estrogen use and cardiovascular disease risk.
      STUDY DESIGN: Data were obtained from baseline (1981 to 1984) and follow-up (1990 to 1992) health surveys of two cohorts randomly selected from communities in southeastern New England. At follow-up postmenopausal women ≥40 years old were catagorized as current users (n = 70) or nonusers (n = 772) of noncontraceptive estrogens. Users and nonusers were compared on both prior characteristics from the baseline surveys and current characteristics measured at follow-up by use of analysis of covariance.
      RESULTS: Prior levels of total and high-density lipoprotein cholesterol, body mass index, and blood pressure were similar for estrogen users and nonusers. Estrogen users were less likely to have smoked and more likely to have had their cholesterol checked and to exercise regularly. These differences were more pronounced for current characteristics than for baseline characteristics.
      CONCLUSIONS: Selection of healthy women for treatment may not fully explain the apparent protective effect of estrogen replacement on cardiovascular risk. However, more healthy profiles among estrogen users may inflate the apparent benefit of treatment in observational studies.

      Keywords

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      References

        • Stampfer MJ
        • Colditz G
        Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence.
        Prev Med. 1991; 20: 47-63
        • Grady D
        • Rubin SM
        • Petitti DB
        • et al.
        Hormone therapy to prevent disease and prolong life in postmenopausal women.
        Ann Intern Med. 1992; 117: 1016-1037
        • Barrett-Connor E
        • Bush TL
        Estrogen and coronary heart disease in women.
        JAMA. 1991; 265: 1861-1867
        • Ernster VL
        • Bush TL
        • Huggins GR
        • Hulka BS
        • Kelsey JL
        • Schottenfeld D
        Benefits and risks of menopausal estrogen and/or progestin hormone use.
        Prev Med. 1988; 17: 201-223
        • Bush TL
        • Barrett-Connor E
        • Cowan LD
        • et al.
        Cardiovascular mortality and noncontraceptive use of estrogen in women: results from the Lipid Research Clinics program follow-up study.
        Circulation. 1987; 75: 1102-1109
        • Henderson BE
        • Paganini-Hill A
        • Ross RK
        Decreased mortality in users of estrogen replacement therapy.
        Arch Intern Med. 1991; 151: 75-78
        • Stampfer MJ
        • Willett WC
        • Colditz GA
        • Rosner B
        • Speizer FE
        • Hennekens CH
        A prospective study of postmenopausal estrogen therapy and coronary heart disease.
        N Engl J Med. 1985; 313: 1044-1049
        • Henderson BE
        • Paganini-Hill A
        • Ross RK
        Estrogen replacement therapy and protection from acute myocardial infarction.
        An J Obstet Gynecol. 1988; 159: 312-317
        • Wilson PWF
        • Garrison RJ
        • Castelli WP
        Postmenopausal estrogen use, cigarette smoking and cardiovascular morbidity in women over 50: the Framingham study.
        N Engl J Med. 1985; 313: 1038-1043
        • Stampfer MJ
        • Colditz GA
        • Willett WC
        • et al.
        Postmenopausal estrogen therapy and cardiovascular disease: ten year follow-up from the Nurses' Health Study.
        N Engl J Med. 1991; 325: 756-762
        • Petitti DB
        • Perlman JA
        • Sidney S
        Noncontraceptive estrogens and mortality: long-term follow-up of women in the Walnut Creek study.
        Obstet Gynecol. 1987; 70: 289-293
        • Nabulsi AA
        • Folsom AR
        • White A
        • et al.
        Association of hormone-replacement therapy with various cardiovascular risk factors in postmenopausal women.
        N Engl J Med. 1993; 328: 1069-1075
        • Cauley JA
        • Cummings SR
        • Black DM
        • Mascioli SR
        • Seeley DG
        Prevalence and determinants of estrogen replacement therapy in elderly women.
        Am J Obstet Gynecol. 1990; 163: 1438-1444
        • Rosenberg L
        • Palmer JR
        • Shapiro S
        A case-control study of myocardial infarction in relation to use of estrogen supplements.
        Am J Epidemiol. 1993; 137: 54-63
        • Hemminski E
        • Malin M
        • Topo P
        Selection to postmenopausal therapy by women's characteristics.
        J Clin Epidemiol. 1993; 46: 211-219
        • Garrison RJ
        • Gold RS
        • Wilson PWF
        • Kannel WB
        Educational attainment and coronary heart disease risk: the Framingham Offspring Study.
        Prev Med. 1993; 22: 54-64
        • Egeland GM
        • Matthews KA
        • Kuller LH
        • Kelsey SF
        Characteristics of noncontraceptive hormone users.
        Prev Med. 1988; 17: 403-411
        • Hemminki E
        • Brambilla DJ
        • McKinlay SM
        • Posner JG
        Use of estrogens among middle-aged Massachusetts women.
        Drug Intell Clin Pharm. 1991; 25: 418-422
        • Barrett-Connor E
        • Wingard DL
        • Criqui MH
        Postmenopausal estrogen use and heart disease risk factors in the 1980's: Rancho Bernardo, Calif., revisited.
        JAMA. 1989; 261: 2095-2100
        • Egeland GM
        • Kuller LH
        • Matthews KA
        • Kelsey SF
        • Cauley J
        • Guzick D
        Premenopausal determinants of menopausal estrogen use.
        Prev Med. 1991; 20: 343-349
        • Derby CA
        • Hume AL
        • Barbour MM
        • McPhillips JB
        • Lasater TM
        • Carleton RA
        Correlates of postmenopausal estrogen use: trends through the 1980's in two New England communities.
        Am J Epidemiol. 1993; 137: 1125-1135
        • Carleton RA
        • Lasater TM
        • Assaf AR
        • Lefebvre RC
        • McKinlay SM
        The Pawtucket Heart Health Program. I: an experiment in population based disease prevention.
        RI Med J. 1987; 70: 533-538
        • Posthuma WFM
        • Westendorp RGJ
        • Vandenbroucke JP
        Cardioprotective effect of hormone replacement therapy in postmenopausal women: is the evidence biased?.
        BMJ. 1994; 308: 1268-1269
        • Ravnikar VA
        Compliance with hormone therapy.
        Am J Obstet Gynecol. 1987; 156: 1332-1334
        • Standeven M
        • Criqui MH
        • Klauber MR
        • Gabriel S
        • Barrett-Connor E
        Correlates of change in postmenopausal estrogen use in a population-based study.
        Am J Epidemiol. 1986; 124: 268-274