A Prospective Study of Postmenopausal Estrogen Therapy and Coronary Heart Disease

THE possible role of exogenous estrogens in coronary heart disease has been controversial for decades. The observations that premenopausal women are at lower risk for coronary disease than postmenopausal women and that estrogens favorably influence serum lipid levels^{1 2 3} led investigators to test estrogen in a trial among men with a prior myocardial infarction.⁴ However, estrogen therapy was stopped when an excess of coronary disease was observed.^4,5 One case–control study in women showed an elevated risk of coronary disease among estrogen users,^6,7 but several recent investigations have found an inverse association.^8,9 In the United States, postmenopausal hormones are used by 2.