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Review: observational studies adjusting for socioeconomic status and lifestyle show no association between HRT and CAD

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 QUESTION: What is the effectiveness of postmenopausal hormone replacement therapy (HRT) for primary prevention of cardiovascular disease?

Data sources

Studies were identified by searching Medline and Cochrane databases from 1966 to December 2000 and by reviewing bibliographies of relevant studies and other publications.

Study selection

Studies were selected if they were randomised controlled trials (RCTs), cohort studies, or case control studies that assessed the use of HRT for primary prevention of cardiovascular disease in postmenopausal women and if English language abstracts were available.

Data extraction

Data were extracted on study design, type of HRT (unopposed oestrogen or oestrogen plus progestin), definitions of cardiovascular disease, and potential risk factors included in multivariate models. 2 investigators independently assessed the quality of individual studies. Formal review and meta-analysis were limited to studies of good or fair quality and included RCTs, cohort studies with internal controls, and population based case control studies with ≥3 years of follow up. HRT use was classified as current, past, ever, or any (combined current, past, or ever).

Main results

Only the results for coronary artery disease (CAD) incidence are reviewed …

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  • For correspondence: Dr L L Humphrey, Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR, USA. humphreyl{at}

  • Abstract and commentary also appear in ACP Journal Club.

  • Source of funding: Agency for Healthcare Research and Quality.