Main morbidities recorded in the women’s international study of long duration oestrogen after menopause (WISDOM): a randomised controlled trial of hormone replacement therapy in postmenopausal women. Dr J Romain ( BMJ 4.8.2007 335:239-244)
Intention-to-treat principle when assessing treatment effects, with P<0.05 used to define statistical significance
To account for the prospective nature of the data, event rates were calculated (per 10 000 women-years) as the number of events divided by the relevant accumulated person-time
The results are reported as, respectively, rates and hazard ratios for the effect of combined therapy versus either placebo or oestrogen therapy (with 95% confidence intervals), with associated likelihood ratio tests for significance
Data suggests that women starting or restarting combined oestrogen and progestogen therapy an average of 15 years after menopause are at increased risk of cardiovascular disease and venous thromboembolism, at least in the early years of treatment
Trend towards a decreased risk of osteoporotic fracture
Early increased risk of cardiovascular events in BOTH trials is compatible with the hypothesis that administration of hormone replacement therapy, particularly combined oestrogen and progestogen therapy, to women many years after menopause, who are likely to have established atherosclerosis, may cause disruption of the plaque surface, with subsequent platelet adhesion, clotting, and further arterial narrowing.
results of WISDOM, help test the hypothesis that starting long term hormone replacement therapy in elderly, often asymptomatic, women in their 60s might reduce major morbidities, in particular cardiovascular disease. This does NOT seem likely.
Currently it is rare to start taking therapy at this age