Week 2: WHI

Question 1

Interpretation of WHI data

Answer 1

• can’t be extrapolated to the typical population using HT. Avg. age was 63 at screening.
• Majority of women initiate HT to alleviate menopausal symptoms
• Women with severe menopausal symptoms were excluded from trial
• 75% of HT users initiate therapy within 5 years of menopause; mean age of menopause, 51 years
• Menopausal age of patients in WHI has not yet been reported

Question 2

Comparison of WHI results with observational studies

Answer 2

AGREE
-increase in VTE with oral HRT
-increase in Breast cancer diagnosis with HRT. (1.2x greater risk)
-Increase CVA when started in older women
-decrease hip fracture
-decrease in colon cancer
DISAGREE
-increase in CHD
-increase in dementia only >age70 in first year of HRT (found to be decreased with ERT in cohort study)
-E alone protective in breast cancer

Question 3

Problems in WHI study

Answer 3

• HTN not controlled
• high rates of unblinding in the HRT vs placebo arm of study
• global index created for the study not validated and significance of assigning equal weights to various conditions unexamined
• statistical analyses: confusion in reporting type of Confidence interval used