*****
Summary of Transcript:
The podcast features Dr. Joanne Manson, a highly esteemed physician and professor of medicine who played a crucial role in conducting the Women’s Health Initiative (WHI) in the 1990s. The WHI was a randomized experiment that aimed to test the hypothesis generated by earlier observational studies that hormone replacement therapy (HRT) can prevent chronic diseases in postmenopausal women. The previous studies had indicated that women on HRT generally had lower rates of heart disease, better cognitive function, and lower all-cause mortality rates than women not on HRT. However, as Dr. Manson highlights, observational studies cannot prove a cause-and-effect relationship but only generate hypotheses that can be tested in controlled clinical trials. With this in mind, the WHI was designed to investigate the benefits and risks of HRT in a randomized clinical trial comprising over 160,000 postmenopausal women who were followed for an average of 5.6 years. The study found that HRT did not reduce the risk of heart disease, cognitive decline, or all-cause mortality but increased the risk of breast cancer, stroke, blood clots, and other adverse effects. The findings of the WHI were interpreted by many as implying that HRT was dangerous and had no benefits, leading to a sharp decline in HRT use and a significant shift in menopausal medicine. However, as Dr. Manson argues, the misinterpretation of the WHI results and the oversimplification of the complex issues surrounding HRT have created a lot of confusion and caused harm to women’s health, as many women who could benefit from HRT remain afraid to use it or are not getting adequate information about its risks and benefits. Through her extensive research, Dr. Manson continues to explore the role of nutrition, lifestyle, and other factors in chronic disease prevention and strives to translate the science of longevity into accessible information for everyone.
*****
Summary of Description:
In this episode of the Peter Attia Drive, JoAnn Manson discusses the Women’s Health Initiative and the benefits and risks of hormone replacement therapy (HRT). Manson explains the study design, primary outcome, confounding factors, breast cancer data, and way forward for better HRT practices. She also addresses the misinterpretation of the WHI results and sensationalized headlines regarding an elevated risk of breast cancer, which led to a significant shift in the perception and utilization of HRT. The podcast also covers the relationship between estrogen and breast cancer, HRT and bone health, the importance of timing HRT, and more.
*****
Understanding the Women’s Health Initiative Study on Hormone Replacement Therapy with JoAnn Manson
JoAnn Manson is a well-known endocrinologist, epidemiologist, and Principal Investigator for the Women’s Health Initiative (WHI). This study examined the risks and benefits of hormone replacement therapy (HRT) for postmenopausal women. The study has significantly impacted the perception and utilization of HRT. In this episode of The Peter Attia Drive, JoAnn provides an in-depth analysis of the study design, primary outcome, confounding factors, and nuanced benefits and risks of HRT.
The Original Goals of the Study
The WHI study was launched in 1991 with the primary goal of examining the effect of HRT on the incidence of heart disease, stroke, and breast cancer. The study was conducted on over 160,000 women aged 50 to 79, who were followed for an average of eight years. The study used two hormone formulations, estrogen-only and estrogen-plus progestin therapy.
Study Design and Primary Outcome
JoAnn explains that the study design was a randomized controlled trial, considered the gold standard for clinical studies. The primary outcome measure was the incidence of heart disease, stroke, and breast cancer in the group receiving HRT compared to the control group. However, the study also examined other outcomes such as hip fractures, dementia and cognitive decline, and quality of life.
JoAnn’s Hypothesis
JoAnn shares her hypothesis about the ability of HRT to reduce heart disease risk before the WHI study. She explains that there was a lot of evidence at the time that estrogen had a protective effect on the cardiovascular system. She was surprised that the study’s results did not support her hypothesis.
Estrogen and Breast Cancer
One of the most significant findings of the WHI study was the alleged increase in breast cancer risk in women receiving HRT. JoAnn explains that this was a misinterpretation of the data, and the actual risk is relatively small. She clarifies that estrogen alone therapy does not increase breast cancer risk, but the risk is slightly elevated when progestin is added. Additionally, the risk returns to normal after stopping HRT.
Moving Towards Better HRT Practices
JoAnn believes HRT can be a beneficial treatment option for postmenopausal women, especially those experiencing severe menopausal symptoms. However, she emphasizes that the decision to use HRT should be made individually, considering the woman’s age, medical history, and risk factors. She also stresses the importance of finding a knowledgeable clinician about HRT who can provide personalized recommendations.
Final Thoughts
The episode provides a comprehensive overview of the WHI study and offers valuable insights into the benefits and risks of HRT for postmenopausal women. JoAnn concludes the episode by discussing the potential impact of HRT on mortality and the need for more studies on the long-term effects of the treatment. She believes there is a lot of room for improvement regarding HRT practices and encourages physicians to stay informed about the latest research in the field.
*****
Source Description
Watch the full episode and view show notes here: https://bit.ly/3HJxWwn
Become a member to receive exclusive content: https://peterattiamd.com/subscribe/
Sign up to receive Peter’s email newsletter: https://peterattiamd.com/newsletter/
JoAnn Manson is a world-renowned endocrinologist, epidemiologist, and Principal Investigator for the Women’s Health Initiative (WHI). In this episode, she dives deep into the WHI to explain the study design, primary outcome, confounding factors, and nuanced benefits and risks of hormone replacement therapy (HRT). JoAnn reflects on how a misinterpretation of the results and sensationalized headlines regarding an elevated risk of breast cancer led to a significant shift in the perception and utilization of HRT. From there, they take a closer look at the breast cancer data to separate fact from fiction. Additionally, JoAnn gives her take on how one should weigh the risks and benefits of HRT and concludes with a discussion on how physicians can move towards better HRT practices.
We discuss:
Intro [0:00]
The Women’s Health Initiative: the original goal of the study, hormone formulations used, and potential confounders [4:15];
Study design of the Women’s Health Initiative, primary outcome, and more [16:00];
JoAnn’s hypothesis about the ability of hormone replacement therapy to reduce heart disease risk before the WHI [26:45];
The relationship between estrogen and breast cancer [30:45];
Why the WHI study was stopped early, and the dramatic change in the perception and use of HRT due to the alleged increase in breast cancer risk [37:30];
What Peter finds most troubling about the mainstream view of HRT and a more nuanced look at the benefits and risks of HRT [45:15];
HRT and bone health [56:00];
The importance of timing when it comes to HRT, the best use cases, and advice on finding a clinician [59:30];
A discussion on the potential impact of HRT on mortality and a thought experiment on a long-duration use of HRT [1:03:15];
Moving toward better HRT practices, the need for more studies [1:10:00]; and
More.
——–
About:
The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity and all that goes into that, from physical to cognitive to emotional health. With over 60 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and more.
Peter Attia is the founder of Early Medical. This medical practice applies the principles of Medicine 3.0 to patients to lengthen their lifespan and simultaneously improve their healthspan.
Learn more: https://peterattiamd.com.
Connect with Peter on:
Facebook: http://bit.ly/PeterAttiaMDFB
Twitter: http://bit.ly/PeterAttiaMDTW
Instagram: http://bit.ly/PeterAttiaMDIG
Subscribe to The Drive:
Apple Podcast: http://bit.ly/TheDriveApplePodcasts
Overcast: http://bit.ly/TheDriveOvercast
Spotify: http://bit.ly/TheDriveSpotify
Google Podcasts: http://bit.ly/TheDriveGoogle
Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. Using this information and the materials linked to this podcast is at the user’s risk. The content on this podcast is not intended to substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such needs. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website, where I keep an up-to-date and active list of such companies.
