Terapia de Reemplazo Hormonal

La terapia hormonal de reemplazo no debe ser utilizada rutinariamente para prevenir enfermedades cronicas en mujeres postmenopausicas.

Clinical question When should hormone replacement therapy be used in postmenopausal women?

Bottom line Estrogen/progestin therapy should not routinely be used to prevent chronic disease in postmenopausal women. The Task Force making this recommendation did not address short-term (1-2 years) treatment of symptoms of menopause. The risks with chronic therapy are minimal, but so are the benefits to chronic disease prevention. (LOE = 1a)

Reference U.S. Preventive Services Task Force. Hormone therapy for the prevention of chronic conditions in postmenopausal women: Recommendations from the U.S. Preventive Services Task Force. Ann Intern Med 2005;142:855-60.

Study design: Practice guideline

Setting: Various (guideline)

Synopsis The United States Preventive Services Task Force recommends against the routine use of estrogen/progestin therapy for the prevention of chronic conditions in postmenopausal women (grade D recommendation; ie, fair evidence that treatment is ineffective or potential harm outweighs potential benefit). The Task Force cites good evidence that hormone replacement reduces risk of fracture and colorectal cancer. Hormone replacement has no beneficial effect on coronary heart disease and may, in fact, increase risk. Other increased risks: breast cancer, venous thromboembolism, stroke, cholecystitis, dementia, and lower cognitive function. However, the risks are small: for every 10,000 women taking hormone replacement for 1 year, there will be 7 more events related to coronary heart disease, 8 more strokes, 8 more pulmonary embolisms, and 8 more cases of breast cancer. There will also be 6 fewer cases of colorectal cancer and 5 fewer hip fractures. Similarly, the Task Force recommends against routine use of unopposed estrogen (grade D recommendation).

Statins equivalent for CVD prevention

Clinical Question:

Are there any differences in outcomes among the major statins?

Bottom Line:

The overall effectiveness of statin therapy on the most important outcomes -- decreasing mortality, heart attacks, and strokes -- is not different among the 3 major statins. These are the results from a meta-analysis; no study has directly compared equivalent doses of 2 statins. (LOE = 1a)

Reference:

Zhou Z, Rahme E, Pilote L. Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention. Am Heart J 2006;151:273-81.

Study Design:

Meta-analysis (randomized controlled trials)

Funding:

Self-funded or unfunded

Setting:

Outpatient (any)

Synopsis:

The researchers conducted this analysis of the research on the benefit of statins in the prevention of cardiovascular disease (CVD). The statins under consideration were pravastatin (Pravachol), simvastatin (Zocor), and atorvastatin (Lipitor). They authors identified, through a search of MEDLINE and the Cochrane Controlled Trials Register databases, all randomized controlled trials of at least 1000 participants that evaluated CVD or mortality as an outcome over the course of at least 1 year. The used only English language studies. They took other short cuts in the systematic review process that likely had little effect on their conclusions; they did not perform duplicate searching or data abstraction. They identified 8 studies enrolling almost 64,000 people that compared 1 of the statins with either placebo or usual care. The authors did not include the single study that directly compared 2 statins since the marketing-friendly goal of that study was to compare the intensity of treatment rather than the relative effectiveness of the 2 drugs. All studies showed a similar degree of reduction in lipid levels. There was no difference among the statins in reducing fatal coronary heart disease, nonfatal myocardial infarctions, fatal and nonfatal strokes, all cardiovascular deaths, or mortality due to any cause.

Statins equivalent for CVD prevention

Clinical Question:

Are there any differences in outcomes among the major statins?

Bottom Line:

The overall effectiveness of statin therapy on the most important outcomes -- decreasing mortality, heart attacks, and strokes -- is not different among the 3 major statins. These are the results from a meta-analysis; no study has directly compared equivalent doses of 2 statins. (LOE = 1a)

Reference:

Zhou Z, Rahme E, Pilote L. Are statins created equal? Evidence from randomized trials of pravastatin, simvastatin, and atorvastatin for cardiovascular disease prevention. Am Heart J 2006;151:273-81.

Study Design:

Meta-analysis (randomized controlled trials)

Funding:

Self-funded or unfunded

Setting:

Outpatient (any)

Synopsis:

The researchers conducted this analysis of the research on the benefit of statins in the prevention of cardiovascular disease (CVD). The statins under consideration were pravastatin (Pravachol), simvastatin (Zocor), and atorvastatin (Lipitor). They authors identified, through a search of MEDLINE and the Cochrane Controlled Trials Register databases, all randomized controlled trials of at least 1000 participants that evaluated CVD or mortality as an outcome over the course of at least 1 year. The used only English language studies. They took other short cuts in the systematic review process that likely had little effect on their conclusions; they did not perform duplicate searching or data abstraction. They identified 8 studies enrolling almost 64,000 people that compared 1 of the statins with either placebo or usual care. The authors did not include the single study that directly compared 2 statins since the marketing-friendly goal of that study was to compare the intensity of treatment rather than the relative effectiveness of the 2 drugs. All studies showed a similar degree of reduction in lipid levels. There was no difference among the statins in reducing fatal coronary heart disease, nonfatal myocardial infarctions, fatal and nonfatal strokes, all cardiovascular deaths, or mortality due to any cause.