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Back To Vidyya Estrogen's Protection Against Dying From All Causes Measured In American Cancer Society Study

Hormone's Benefits Found Greatest For Thinner Women

Women who use estrogen after menopause have lower death rates from all causes than those who do not, reports American Cancer Society researchers, and this reduction in death is greatest for coronary heart disease and for thinner women.

These findings, based on an analysis of data from the Society's landmark Cancer Prevention Study II, is published in the January 15th edition of the American Journal of Epidemiology.

Carmen Rodriguez, Ph.D. and colleagues from the American Cancer Society's Epidemiology and Surveillance Research Department, responding to recent evidence suggesting that the impact of estrogen use on disease outcomes may vary by body mass, studied a group of 290,827 postmenopausal, primarily elderly U.S. women. These women had no history of cancer or cardiovascular disease when they were enrolled in the 1.2 million participant American Cancer Society prospective study in l982.

After 12 years of follow-up, death rates from all causes among these women were nearly 20% lower (Rate Ratio = 0.82) among estrogen users compared with non-users.

Estrogen users typically have healthier lifestyles and better cardiovascular profiles than do non-users, which according to the researchers may explain in part their lower death rates. However, the findings in this analysis, say the authors, show a coronary heart disease rate that is larger than would be explained by this "healthy user" bias.

The largest decrease in death rates was found in coronary heart disease (CHD) and other circulatory diseases, (RR = 0.66 CHD, RR = 0.70, other circulatory diseases). The rate ratio for CHD mortality associated with estrogen use was significantly lower for the leanest women, those with a body mass index (BMI) of less than 22. These women had a RR of 0.49. Body mass index is a ratio of weight in pounds divided by height in inches squared. A woman with BMI of less than 25 is considered thin or normal weight, between 25 and 30 is considered overweight, and BMI of 30 or more is considered obese.

"Estrogen did not seem to lower the risk of dying from coronary heart disease for women with a BMI of 30 or higher," reports Dr. Rodriguez. "Overall, the risk of dying from coronary heart disease increases with greater body mass index. Estrogen use decreases risk of dying from coronary heart disease among thin and overweight women, but no impact was observed among obese women" she observes.

The association of cancer mortality with estrogen use was found to be minimal reports the study team. Cancer death rates were modestly lower among estrogen users (RR = 0.91) and did not change overall in relation to BMI.

Some previous studies of women with established CHD have reported that the use of estrogen did not protect against subsequent coronary disease events.

"Our findings do not conflict with findings from those studies," says Dr. Rodriguez. "That's because we were looking at the hormone's effect on women with no pre-existing heart disease.

"Our study does suggest that when a woman and her physician are in the process of deciding for or against using hormone replacement at menopause, body size should be another consideration in the estimation of potential risks and benefits of the therapy," she added.

The American Cancer Society is the nationwide community-based voluntary health organization dedicated to eliminating cancer as a major health problem by preventing cancer, saving lives and diminishing suffering from cancer, through research, education, advocacy and service.

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Editor: Susan K. Boyer, RN
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