Researchers from the Brigham and colleagues report on the long-term follow-up of the biggest examine of ladies’s well being within the U.S., shedding gentle on the position of menopausal hormone remedy, calcium and vitamin D supplementation, and a low-fat dietary sample amongst postmenopausal girls
Greater than 1.1 billion girls worldwide are postmenopausal. A evaluation paper by authors from Brigham and Ladies’s Hospital and different main consultants from throughout the nation helps to reply a number of the most urgent questions in postmenopausal girls’s well being and to fill key information gaps to enhance well being after menopause.
Leveraging knowledge from The Ladies’s Well being Initiative (WHI), the authors current steering about menopausal hormone remedy (HT), calcium and vitamin D supplementation, and low-fat dietary sample. The evaluation paper is published in JAMA.
Primarily based on long-term WHI follow-up (as much as 20 years), the researchers report that youthful girls (under age 60) had decrease charges of hostile occasions and a extra favorable benefit-to-risk ratio of HT than girls in later menopause. Though HT shouldn’t be used to forestall coronary heart illness, stroke, dementia, or different power illnesses, the WHI findings help its use in early menopause for therapy of moderate-to-severe sizzling flashes, night time sweats, and different menopausal signs, which is an FDA-approved indication.
“The WHI findings ought to by no means be used as a purpose to disclaim hormone remedy to girls in early menopause with bothersome menopausal signs. Many ladies are good candidates for therapy and, in shared determination making with their clinicians, ought to have the ability to obtain acceptable and personalised well being care for his or her wants,” stated JoAnn Manson, MD, Chief of Preventive Drugs at Brigham and Ladies’s Hospital and first writer of the brand new report in JAMA.
Manson added, “Ladies even have extra choices for therapy now, together with estrogen in decrease doses and delivered via the pores and skin as a patch or gel, which can additional scale back dangers; non-hormonal therapies are additionally obtainable.”
Concerning calcium and vitamin D dietary supplements, WHI outcomes don’t help routinely recommending these dietary supplements for fracture prevention in all postmenopausal girls. Nevertheless, calcium and vitamin D dietary supplements are acceptable to fill dietary gaps for girls who don’t meet nationwide pointers for intakes of those vitamins via food plan.
Lastly, a low-fat dietary sample with elevated fruit, vegetable, and grain consumption didn’t scale back the danger of breast or colorectal most cancers however was related to a decrease threat of breast most cancers mortality greater than a decade after the trial ended.
“A dietary sample low in fats and excessive in fruits, greens, and grains confirmed advantages for lowering deaths from breast most cancers in long-term follow-up, providing an possibility for girls looking for to scale back these dangers,” stated Manson.
The Brigham’s Division of Preventive Drugs was one of many vanguard facilities for the WHI, which included multi-center, randomized trials initiated by the Nationwide Institutes of Well being. The WHI, the biggest examine of ladies’s well being within the U.S., enrolled greater than 160,000 postmenopausal girls aged 50–79 in research to forestall coronary heart illness, most cancers (particularly breast and colorectal most cancers), and hip fractures.
Greater than 68,000 girls enrolled in randomized scientific trials to check the well being results of menopausal HT, calcium plus vitamin D supplementation, and low-fat dietary modification. The WHI observational examine addressed a variety of questions associated to wholesome growing old and power illness prevention.
When the WHI started recruitment in 1993, observational research had reported that postmenopausal girls who took HT had decrease dangers of coronary heart illness, stroke, dementia, different power illnesses, and all-cause mortality than girls not taking HT.
“Within the early Nineteen Nineties, almost 15 million U.S. girls acquired HT prescriptions every year and HT was usually (and more and more) prescribed to attempt to forestall heart problems and different power illnesses amongst girls in each early and late menopause, whether or not or not the affected person had sizzling flashes or different menopausal signs,” stated Manson.
“Nevertheless, no randomized trials had been executed in postmenopausal girls to judge the advantages and dangers of HT for power illness prevention. Satirically, the one randomized trial of estrogen had been executed in males.”
The WHI examined essentially the most used formulations of HT on the time. The examine was not designed to judge HT for therapy of sizzling flashes or different menopausal signs as a result of these advantages of HT had been already well-established; and this was an FDA-approved indication to be used.
Calcium and vitamin D dietary supplements had been studied within the WHI as a result of they’d been beforehand examined primarily in populations with osteoporosis or low bone mineral density, and no prior scientific trial had evaluated their advantages and dangers amongst postmenopausal girls with typical fracture threat.
A low-fat dietary sample was examined as a result of observational research urged that individuals with increased consumption of dietary fats and fewer vegatables and fruits had increased charges of breast and colorectal most cancers.
“This new WHI report, for the primary time, offers scientific messages for well being care suppliers and for most of the people from the long-term follow-up of the entire trials,” stated Manson.
Extra data:
JoAnn Manson et al, The Ladies’s Well being Initiative randomized trials and scientific apply: A evaluation. JAMA (2024). DOI: 10.1001/jama.2024.6542.
Quotation:
Lengthy-term follow-up studies key findings and scientific messages from largest examine of ladies’s well being within the US (2024, Could 1)
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