Reserving judgement on HRT

Regarding our commentary,¹ Lianne Lacroix speculates that the ongoing arm of the Women's Health Initiative Trial evaluating estrogens alone versus placebo has not been stopped because the results may be beneficial. Such speculation is dangerous, as there are no data from any randomized controlled trials that estrogen alone improves clinical outcomes in patients who take this preparation routinely. Until the results of the estrogen component of the WHI are available, prudence would dictate caution. While we do not “condemn all other hormone preparations,” absence of proof of harm should not be assumed to mean proof of absence of harm. Therefore, it would be premature to recommend the routine use of any hormone preparation for the prevention of major vascular events until we have clear evidence of benefit from well-designed trials.

Salim Yusuf Professor of Medicine Sonia Anand Assistant Professor of Medicine McMaster University Hamilton, Ont.