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Postmenopausal Hormone Replacement

IN RESPONSE: Panico and colleagues predict that if the rate of death from ischemic heart disease continues to decrease, mortality rates for ischemic heart disease and breast cancer will become equivalent for U.S. women 50 to 70 years of age by 2008. From a population-based perspective, the greatest benefit of HRT is hypothesized to be cardiovascular risk reduction, and the greatest risk is an increase in breast cancer; therefore, a decrease in mortality from ischemic heart disease could greatly affect the riskbenefit ratio. This line of reasoning is interesting and potentially important, but we do not believe it is relevant to our findings. First, in our study, most of the women physicians were at relatively low risk for heart disease. Second, for women who reported cardiovascular risk factors (history of a sedentary life-style, diabetes, high cholesterol levels, high blood pressure, smoking, or a family or personal history of heart disease), these factors were not significantly associated with the personal use of HRT. Thus, we do not believe that women physicians chose to use HRT to protect their hearts, and so any future change in the ischemic heart disease mortality rate would not affect their decision to use HRT. We hypothesized that the higher rates of HRT use by women physicians may presage higher use by U.S. women in general because the health-related behaviors of physicians and other groups with high socioeconomic status have been shown to change before behaviors of society as a whole change [1]. We continue to believe this to be a reasonable hypothesis.