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iqbal malik

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HRT seems to have short term risk for long term gain: The HERS trial did not show an overall cardiovascular benefit for hormone replacement therapy (HRT) over five years, but suggested an initial early risk, followed by a reduced risk of cardiac events in years 2–5. The new data from 2489 nurses with proven atherosclerotic disease in the nurses health study suggests the same, with recurrent cardiac events occurring with a relative risk (RR) of 1.25 (95% confidence interval (CI) 0.78 to 2.00) compared with never users in the first year. However, after longer term hormone use, the rate of second events was lower in current users than in never users (RR 0.38, 95% CI 0.22 to 0.66). Overall, with up to 20 years of follow up, the relative risk for a second event among current users of HRT was 0.65 (95% CI 0.45 to 0.95) compared with never users. So, HRT may be of benefit in secondary prevention of coronary heart disease.

 1 Grodstein F, Manson JE, Stampfer MJ. Postmenopausal hormone use and secondary prevention of coronary events in the nurses' health study: a prospective, observational study.

  2 Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B, Vittinghoff E. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and estrogen/progestin replacement study (HERS) research group. .

The post-code lottery: Where a person lives is not normally thought to be an independent risk factor for coronary heart disease. Using data from the atherosclerosis risk in communities study, the relation between characteristics of neighbourhoods and the …

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  • Journals scanned—American Journal of Medicine; American Journal of Physiology: Heart and Circulatory Physiology; Annals of Emergency Medicine; Annals of Thoracic Surgery; Archives of Internal Medicine; BMJ; Chest; European Journal of Cardiothoracic Surgery; Lancet; JAMA; Journal of Clinical Investigation; Journal of Diabetes and its Complications; Journal of Immunology; Journal of Thoracic and Cardiovascular Surgery; Nature Medicine; New England Journal of Medicine; Pharmacoeconomics; Thorax. Reviewers—C Baker, E Barnes, V Bhatia, R Desilva, M Earley, K Fox, D Gorog, G Jenkins, R Kaprilian, A Kapur, M Khan, P Lambiese, V Markides, M Poullis, P Ramrakha, J Strange, B Wasan, H Walker.