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Diet Modification (DM) Trial Primary Outcomes: Breast & Colorectal Cancer Secondary Outcome: Coronary Heart Disease (CHD)
Hormone (HRT) Trial Primary Outcome: CHD Secondary Outcomes: Hip Fracture, Breast Cancer Ancillary Study: Memory
11.8% Overlap
Average Follow-up 8.5 years
Average 8.4 years
DM
48,836
HRT27, 347
LRC LRC Prevalence StudyPrevalence Study (‘83,’87)(‘83,’87) Nurses’ Health Study Nurses’ Health Study (‘85, ‘91)(‘85, ‘91) Framingham Study Framingham Study (‘85)-reversed(‘85)-reversed Nurses’ Nurses’ Health Study Health Study (‘97) (‘97) PERTPERT Survival benefit diminishes
with longer duration use; is lower for women at low risk for CHD - NEJM ‘97: 336; 1769
Many Observational Studies Many Observational Studies HRT users vs nonusers (generally): less likely to smoke, leaner, more physically active, healthier, more educated, higher SES, visit MDs more often, at lower CVD risk
HERS HERS (‘98) prior CHD (+ uterus), aged<80. (‘98) prior CHD (+ uterus), aged<80. PERTPERT for for MI: No benefit MI: No benefit @@ 4 yrs; 4 yrs; incr.incr. 1st yr, 1st yr, decr.decr. 4-5 yrs; 4-5 yrs; incr incr VTE VTE (DVT(DVT&&PE),Gallbladder D.PE),Gallbladder D.
ERAERA (‘00) (‘00) angiographicangiographic CHD. CHD. No ERT or No ERT or PERTPERT benefitbenefit,aver 3.2 yr,aver 3.2 yr
PHASE(‘00); (‘00); [WAVE?; WELL-HART?][WAVE?; WELL-HART?] EPATEPAT LDL≥ 130;if >160,lipid-lowering--No WESTWEST(‘01)(‘01) recent stroke or TIA - recent stroke or TIA - NoNo WHI (2005) women aged 50-79 women aged 50-79
Hormone (HRT) Trial Primary Outcome: Coronary Heart Disease Secondary Outcomes: Hip Fracture; Other Fractures Breast & Endometrial Cancers WHI Memory Study (WHIMS) - for women 65+ - Memory
WHI HRT: Treated Hypertension by Ethnicity and Uterine Status
0
10
20
30
40
50
Total White Black Hispanic Asian/PI
Hysterectomy No HystX
Treated Hypertension by Uterine Status
Per
cent
HRT: High Blood Pressure* by Ethnicity and Uterine Status
* (Systolic BP>140 mmHg; Diastolic BP>90 mmHg)
0
10
20
30
40
Total White Black Hispanic Asian/PIHystX- High SBP No HystX- High SBP
HystX- High DBP No HystX- High DBP
High SBP and DBP (Baseline Clinic Visit) by Uterine Status%
WHI HRT: Treated Diabetes by Ethnicity and Uterine Status
0
2
4
6
8
10
12
14
Total White Black Hispanic Asian/PI
Hysterectomy No HystX
Treated Diabetes (per Questionnaire)
Per
cent
WHI HRT: High Cholesterol requiring Pills by Ethnicity and Uterine Status
0
5
10
15
20
25
30
Total White Black Hispanic Asian/PI
Hysterectomy No HystX
High Blood Cholesterol requiring Pills
Per
cent
WHI HRT: History of MI or CABG/PTCAby Uterine Status and Ethnicity
0
1
2
3
4
5
Total White Black Hispanic Asian/PI
HystX-prior MI No HystX-prior MI
HystX-prior CABG/PTCA No HystX-prior CABG/PTCA
Positive Response to MI or CABG/PTCA Ever
Per
cent
WHI HRT: History of Stroke by Uterine Status and Ethnicity
0
0.5
1
1.5
2
2.5
3
Total White Black Hispanic Asian/PI
Hysterectomy No HystX
Positive Response to Stroke Ever
Per
cent
WHI HRT: Age at First Birth (%) by Uterine Status and Ethnicity
0
10
20
30
40
50
Total White Black Hispanic Asian/PI
No HystX No term pregancy HystX 1st Birth < 20 yrs oldNo HystX 1st Birth < 20 yrs old HystX-1st Birth > 30 yrs oldNo HystX-1st Birth > 30 yrs old
First Birth < 20 Yrs Age or = 30 Yrs of age
Per
cent
WHI HRT: No Live Births by Uterine Status and Ethnicity
0
2
4
6
8
10
Total White Black Hispanic Asian/PI
Hysterectomy No HystX
No Live Births (No term pregnancy)
Per
cent
WHI HRT: Oral Contraceptive Use and Duration by Ethnicity and Uterine Status
0
5
10
15
20
25
Total White Black Hispanic Asian/PI
HystX Used OC < 5 yrs No HystX Used OC < 5 yrsHystX Used OC 5-10 yrs No HystX Used OC 5-10 yrsHystX Used OC > 10 yrs No HystX Used OC = 10 yrsHystX-OC >10 yrs No HystX OC >10 yrs
Percent Using OC for <5, 5-<10 or > 10 yrsP
erce
nt
HRT Use at Baseline and Time Since last used (%) by Ethnicity and Uterine Status
0
4
8
12
16
20
Total White Black Hispanic Asian/PI
HystX- Current No HystX- Current
HystX- Used < 5 yrs ago No HystX- Used < 5 yrs ago
Percent Using HRT Currently or < 5 yrs ago
Per
cent
HRT Use at Baseline and Time Since last used (%) by Ethnicity and Uterus Status
0
5
10
15
20
25
Total White Black Hispanic Asian/PI
HystX Used 5-<10 yrs ago No HystX Used 5-<10 yrs ago
HystX Used = 10 yrs ago No HystX Used = 10 yrs ago