Boston - February 2003, Harvard Medical School affiliate Brigham and Women's Hospital - Researchers from Brigham and Women's Hospital (BWH) have found that the publication of postmenopausal hormone therapy (HT) clinical trial results which detailed health risks may have led to a decrease in usage among women. According to a study appearing in the February 3 issue of the Annals of Internal Medicine, publicized data from the Heart and Estrogen/progestin Replacement Study (HERS) led to a modest decline in the use of HT whereas the Women's Health Initiative (WHI) was associated with a substantial and immediate decline in HT use within many racial and ethnic groups. This has led researchers to believe that effective dissemination of information, such as what was observed with the WHI data, can lead to changes in health behaviors.
According to Jennifer S. Haas, MD of BWH's Department of Medicine, HMS associate professor of medicine, and lead author of the study, "HERS and WHI have significantly contributed to a growing body of evidence that associates HT with heart disease risk among women. However, researchers and clinicians have observed that changes in health practices often lag behind the evidence. What this study suggests is that the successful dissemination of data, specifically in the case of WHI, led to dramatic changes in health practices as women across all ethnic lines stopped using HT. This insight provides clinicians and researchers with an example of how to effectively influence health practices in the future."
Data collected through the past 10 years indicates that hormone therapy can increase a women's risk of developing heart disease. This finding was emphasized in 1998 after the publication of HERS data and again in 2002 after the publication of WHI data. To help determine if publication of this data has an impact on its usage, Haas and her colleagues from the University of California San Francisco looked at information from approximately 71,000 women between the ages of 50 and 74 who participated in the San Francisco Mammography Registry, a population-based registry of women in the San Francisco area undergoing mammography.
According to their findings, before publication of HERS, the use of HT was increasing at a rate of one percent per quarter. After publication of HERS data, the use of HT began decreasing at a rate of one percent per quarter. The release of data from the WHI study was followed by a more substantial decline in use of HT--18 percent per quarter. For both studies, these declines were not associated with age, hysterectomy status or ethnic background.
"The risks associated with hormone therapy use have been heard by several populations of women," Haas said. "Because the publicity surrounding the HERS and WHI results has subsided, researchers and clinicians do not want the message of the potential risk factors associated with HT use to diminish. We need to continue to do a better job about providing our patients with new health risk data and be open to discussing options."