Long-term follow-up reports key findings and clinical messages from largest study of women's health in the US – Medical Xpress
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by Brigham and Women’s Hospital
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 evaluate paper by authors from Brigham and Ladies’s Hospital and different main specialists from throughout the nation helps to reply a number of the most urgent questions in postmenopausal women‘s well being and to fill key data gaps to enhance well being after menopause.
Leveraging information from The Ladies’s Well being Initiative (WHI), the authors current steering about menopausal hormone therapy (HT), calcium and vitamin D supplementation, and low-fat dietary sample. The evaluate paper is published in JAMA.
Primarily based on long-term WHI follow-up (as much as 20 years), the researchers report that youthful girls (beneath age 60) had decrease charges of opposed occasions and a extra favorable benefit-to-risk ratio of HT than girls in later menopause. Though HT shouldn’t be used to stop heart disease, stroke, dementia, or different continual ailments, the WHI findings assist its use in early menopause for remedy of moderate-to-severe scorching 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 remedy and, in shared resolution making with their clinicians, ought to be capable to obtain acceptable and customized well being care for his or her wants,” stated JoAnn Manson, MD, Chief of Preventive Medication at Brigham and Ladies’s Hospital and first creator of the brand new report in JAMA.
Manson added, “Ladies even have extra choices for remedy now, together with estrogen in decrease doses and delivered by the pores and skin as a patch or gel, which can additional cut back dangers; non-hormonal remedies are additionally accessible.”
Relating to calcium and vitamin D dietary supplements, WHI outcomes don’t assist 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 ladies who don’t meet nationwide tips for intakes of those vitamins by weight loss plan.
Lastly, a low-fat dietary sample with elevated fruit, vegetable, and grain consumption didn’t cut back the chance of breast or colorectal most cancers however was related to a decrease danger 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 choice for ladies looking for to scale back these dangers,” stated Manson.
The Brigham’s Division of Preventive Medication 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 stop coronary heart illness, most cancers (particularly breast and colorectal most cancers), and hip fractures.
Greater than 68,000 girls enrolled in randomized clinical 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 older and continual 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 continual ailments, and all-cause mortality than girls not taking HT.
“Within the early Nineties, practically 15 million U.S. girls obtained HT prescriptions annually and HT was usually (and more and more) prescribed to attempt to stop heart problems and different continual ailments amongst girls in each early and late menopause, whether or not or not the affected person had scorching flashes or different menopausal signs,” stated Manson.
“Nevertheless, no randomized trials had been completed in postmenopausal girls to guage the advantages and dangers of HT for continual illness prevention. Sarcastically, the one randomized trial of estrogen had been completed in males.”
The WHI examined probably the most used formulations of HT on the time. The examine was not designed to guage HT for remedy of scorching flashes or different menopausal symptoms as a result of these advantages of HT have been already well-established; and this was an FDA-approved indication to be used.
Calcium and vitamin D dietary supplements have 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 medical trial had evaluated their advantages and dangers amongst postmenopausal girls with typical fracture danger.
A low-fat dietary sample was examined as a result of observational research recommended that individuals with greater consumption of dietary fats and fewer vegatables and fruits had greater charges of breast and colorectal cancer.
“This new WHI report, for the primary time, offers medical 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 info: JoAnn Manson et al, The Ladies’s Well being Initiative randomized trials and medical follow: A evaluate. JAMA (2024). DOI: 10.1001/jama.2024.6542.
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