PRIOR TO USE OF ESTROGEN REPLACEMENT THERAPY, ARE USERS HEALTHIER THAN NONUSERS

Observational studies have demonstrated that women who have used postm enopausal estrogen replacement therapy (ERT) are at reduced risk of co ronary heart disease. The authors examined whether premenopausal women who subsequently elected to use ERT during menopause had a better car diovascular risk factor profile prior to use than did nonusers. A tota l of 541 premenopausal women had their cardiovascular risk factors and psychosocial characteristics evaluated at study entry. After approxim ately 8 years, 355 women had become postmenopausal, and 157 women repo rted ERT use during the follow-up period (mean = 93.4 months). The aut hors compared the premenopausal characteristics of users with those of nonusers. Relative to nonusers, ERT users were better educated (63 vs . 81% with at least some college), and prior to the use of ERT had hig her levels of high density lipoprotein (HDL) cholesterol (1.49 vs. 1.5 9 mmol/liter), HDL2 (0.50 vs. 0.57 mmol/liter), HDL3 (0.98 vs. 1.02 mm ol/liter), leisure physical activity (5,122 vs. 7,158 Kjoules), and al cohol intake (7.5 vs. 9.7 g/day), and lower levels of apolipoprotein B (0.97 vs. 0.90 g/liter), systolic blood pressure (112.1 vs. 107.1 mmH g) and diastolic blood pressure (73.8 vs. 71.4 mmHg), weight (68.5 vs. 64.2 kg), and fasting insulin (9.10 vs. 7.66 mu U/liter). Prior to us of ERT, in comparison with nonusers, subsequent users reported on sta ndardized questionnaires that they more often exhibited Type A behavio r, were more aware of their feelings, motives, and symptoms, and had m ore symptoms of stress. Women who elect to use ERT have a better cardi ovascular risk factor profile prior to the use of ERT than do women wh o subsequently do not use this treatment during the menopause, which s upports the hypothesis that part of the apparent benefit associated wi th use of ERT is due to preexisting characteristics of women who use E RT. This study underscores the widely recognized importance; of random ized clinical trials to estimate the direct benefit of postmenopausal ERT for protecting women from cardiovascular disease.