Racial Differences in Estrogen Use Among Middle-Aged and Older Women

Abstract

Estrogen replacement therapy in postmenopausal women is believed to reduce morbidity and mortality from a variety of conditions. Since the latter part of the 1980s, consideration of estrogen therapy in postmenopausal women has been promoted as a primary and secondary preventive measure against coronary artery disease (CAD).[1]Current recommendations are largely a result of the emergence of epidemiologic data suggesting considerable reductions in risk for coronary artery disease among women who used estrogen. Grady et al[2]summarized the results of 31 observational studies, three meta-analyses, and one randomized controlled trial examining the effect of postmenopausal hormone use on the relative risk of developing CAD. They concluded that hormonal therapy reduces the risk for CAD by 35–50%, with the greatest reductions seen in women diagnosed with CAD. Although most of the participants in these observational studies examining the effects of estrogen on cardiovascular disease were white women, estimates about the effects of estrogen therapy for black women suggest reductions in lifetime probabilities of CAD and gains of 0.9 to 1.9 years of life expectancy.[2]Many professional organizations now recommend consideration of estrogen therapy for all postmenopausal women regardless of race.[3, 4]