New data from the Women’s Health Initiative (WHI) may be reassuring for women on postmenopausal hormone therapy. The data show no higher mortality rate with hormone use after long-term follow-up. The WHI investigators enrolled postmenopausal women 50-79 years of age in two randomized clinical trials between 1993 and 1998, with follow-up through 2014. Women took hormone treatment for five to seven years. The first trial focused on women who were taking conjugated equine estrogen (CEE) plus medroxyprogesterone (MPA) vs. placebo, while the second study focused on CEE alone vs. placebo. Combining all hormone users vs. placebo, during the 18 years of follow-up, all-cause mortality was 27.1% in the hormone therapy group vs. 27.6% in the placebo group (hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.94-1.03). With CEE plus MPA, the HR was 1.02 (95% CI, 0.96-1.08). With CEE alone, the HR was 0.94 (95% CI, 0.88-1.01). Cardiovascular mortality was no higher in the hormone group (HR, 1.00; 95% CI, 0.92-1.08). Total cancer mortality also was not higher (HR, 1.03; 95% CI, 0.95-1.12). The authors concluded that hormone therapy with CEE plus MPA for a median of 5.6 years or with CEE alone for a median of 7.2 years was not associated with risk of all-cause, cardiovascular, or cancer mortality during a cumulative follow-up of 18 years (JAMA 2017;318:927-938).
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