Hormone replacement therapy for African American women: Missed opportunities for effective intervention

Objectives: Because of the potential benefits and risks of hormone replacem ent therapy (HRT), information about the efficacy of HRT in different group s of women is important to patients and providers. The objectives of this s tudy were to review the evidence on the benefits and risks of HRT in Africa n American women and to present a quantitative analysis of the potential re duction in mortality from osteoporotic fractures and coronary heart disease and the potential increase in risk of breast and endometrial cancer. Methods: A MEDLINE search of English-language observational studies and cli nical trials on the effects of HRT on osteoporotic fractures and coronary h eart disease (CHD) was conducted for the time period from 1966 to September 1998. Using available CHD mortality data for African American women and wh ite women, potential reductions in mortality with HRT were explored for Afr ican American and white women. Results: In the 30 studies on CHD and HRT, African American women were know n to comprise only 173 (0.1%) of 148,437 participants. In 11 studies of HRT and osteoporotic fractures, only 128 (0.4%) of 40,299 participants were kn own to be African American women. An analysis of CHD mortality by decade in tervals indicated that African American women, aged 55 to 64, are more like ly to die from CHD each year than white women. Despite a lower incidence of breast and endometrial cancer among African American women, the mortality rates of African American women with these cancers is higher compared with white women. Conclusions: With the higher underlying CHD mortality rate among African Am erican women, HRT is an important potential preventive therapy. The absence of African American women and other non-white women from clinical studies of HRT makes it difficult to fully assess the risks and benefits of HRT in this group of women. (Menopause 1999,6: 147-155. (C) 1999, The North Americ an Menopause Society.)