The professor JoAnn Manson (Harvard Medical School, Brigham and Women’s Hospital, Boston) comments on the latest report on the Women’s Health Initiative (WHI) trials recently published in JAMA . What are the clinical messages to remember, particularly regarding hormonal therapy and calcium and vitamin D supplementation in postmenopausal women?
The WHI is the largest series of studies conducted on women’s health. It was made in the United States [avec un recrutement de plus de 160 000 femmes ménopausées âgées de 50 à 79 ans sur une période de 15 ans].
Previously reported WHI clinical studies focused on individual trials of hormone therapy, calcium, vitamin D, and low-fat diet modification, without emphasizing application to clinical practice. A new report summarizes key findings from all randomized trials from the intervention phase, as well as long-term follow-up, with a focus on implications for clinical practice. [1]
Hormone replacement therapy
The results show that women at the start of menopause (
The results of the WHI study do not support the use of hormone therapy to prevent heart disease, stroke, dementia, or other chronic illnesses.
On the other hand, the WHI study results do not support the use of hormone therapy for the express purpose of trying to prevent heart disease, stroke, dementia, or other illnesses. chronicles. This was the main objective of the WHI trials: to evaluate menopausal hormone therapy based on the benefit/risk ratio when used for the prevention of chronic diseases. The bar is set very high for the use of drugs for prevention, and the risk must be extremely low. But the results are very consistent with FDA-approved indications for treating menopausal symptoms in women in early menopause.
Calcium and vitamin D supplementation
Most previous trials of calcium and vitamin D supplementation have been conducted in women at increased risk of osteoporosis (low bone mineral density, diagnosis of osteoporosis, or history of fracture).
The WHI study was the first randomized trial of calcium and vitamin D for fracture prevention in women at typical fracture risk. The results do not support routine or universal use of calcium and vitamin D supplementation for fracture prevention in all postmenopausal women.
However, the findings support the use of supplementation for women who have nutritional deficiencies and do not meet national recommendations for calcium and vitamin D intake. For example, the Institute of Medicine recommends an intake daily calcium of 1200 mg/day and vitamin D of 600 to 800 IU/day for postmenopausal women. Supplementation is therefore entirely reasonable to help meet these nutritional guidelines.
Low-fat diet
Low-fat diet modification trials included a reduced-fat diet as well as increased consumption of fruits, vegetables, and grains. This eating pattern did not significantly reduce the risk of breast cancer or colorectal cancer. However, long-term follow-up showed a significant reduction in the number of deaths from breast cancer. This dietary pattern is therefore an option for women who are at increased risk of breast cancer and are looking to reduce this risk, and it would be entirely reasonable to recommend this diet in these particular cases.
Conclusion
Overall, the results do not suggest a single answer for these interventions. They should not be universally recommended to all postmenopausal women. However, some women benefited from these interventions, and the results therefore highlight the importance of individualized and personalized health care, as well as shared decision-making with the patient.
JoAnn E. Manson is co-author of the WHI trials discussed in this article. She reported receiving financial support for research from Mars Symbioscience (COSMOS trial).
This article was translated from a transcribed video by Dr. JoAnn Manson published on Medscape.com , using multiple editorial tools, including AI, in the process. The content was reviewed by the editorial staff before publication.
