Francine Grodstein, Sc.D., Meir J. Stampfer, M.D., Graham A. Colditz, M.B., B.S., Walter C. Willett, M.D., JoAnn E. Manson, M.D., Marshall Joffe, M.D., Bernard Rosner, M.D., Charles Fuchs, M.D., Susan E. Hankinson, Sc.D., David J. Hunter, M.B., B.S., Charles H. Hennekens, M.D., and Frank E. Speizer, M.D.
Background Postmenopausal hormone therapy has both benefitsand hazards, including decreased risks of osteoporosis and cardiovasculardisease and an increased risk of breast cancer.
Methods We examined the relation between the use of postmenopausalhormones and mortality among participants in the Nurses' HealthStudy, who were 30 to 55 years of age at base line in 1976.Data were collected by biennial questionnaires beginning in1976 and continuing through 1992. We documented 3637 deathsfrom 1976 to 1994. Each participant who died was matched with10 controls alive at the time of her death. For each death,we defined the subject's hormone status according to the lastbiennial questionnaire before her death or before the diagnosisof the fatal disease; this reduced bias caused by the discontinuationof hormone use between the time of diagnosis of a potentiallyfatal disease and death.
Results After adjustment for confounding variables, currenthormone users had a lower risk of death (relative risk, 0.63;95 percent confidence interval, 0.56 to 0.70) than subjectswho had never taken hormones; however, the apparent benefitdecreased with long-term use (relative risk, 0.80; 0.67 to 0.96,after 10 or more years) because of an increase in mortalityfrom breast cancer among long-term hormone users. Current hormoneusers with coronary risk factors (69 percent of the women) hadthe largest reduction in mortality (relative risk, 0.51; 95percent confidence interval, 0.45 to 0.57), with substantiallyless benefit for those at low risk (13 percent of the women;relative risk, 0.89; 95 percent confidence interval, 0.62 to1.28).
Conclusions On average, mortality among women who use postmenopausalhormones is lower than among nonusers; however, the survivalbenefit diminishes with longer duration of use and is lowerfor women at low risk for coronary disease.
Source Information
From Channing Laboratory (F.G., M.J.S., G.A.C., W.C.W., J.E.M., B.R., C.F., S.E.H., D.J.H., F.E.S.) and the Division of Preventive Medicine (J.E.M., C.H.H.), the Departments of Medicine and of Ambulatory Care and Prevention (C.H.H.), Brigham and Women's Hospital and Harvard Medical School; and the Departments of Epidemiology (F.G., M.J.S., G.A.C., W.C.W., J.E.M., S.E.H., D.J.H., C.H.H.), Nutrition (M.J.S., W.C.W.), and Biostatistics (M.J., B.R.), Harvard School of Public Health — all in Boston.
Address reprint requests to Dr. Grodstein, Channing Laboratory, 181 Longwood Ave., Boston, MA 02115.
Postmenopausal Hormone Therapy and Mortality
Whooley M. A., Grady D., Cummings S. R., Green J., Wintfeld N., Atkins C. D., Grodstein F., Stampfer M. J., Willett W. C.
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N Engl J Med 1997;
337:1389-1391, Nov 6, 1997.
Correspondence
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