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Hsia et al¹ conclude that neither estrogen alone nor estrogen combined with continuous medroxyprogesterone acetate provide protection against coronary heart disease in postmenopausal women in a report of the final results of the Women's Health Initiative (WHI) trial of cardioprotection by hormone therapy. They suggest that, "The views of both the medical and lay communities regarding the role of exogenous estrogen during and after menopause remain in evolution during the current paradigm shift."^1(p364)

The traditional view was that female hormones protect menstruating women against heart disease and that postmenopausal women will therefore derive a similar cardiovascular benefit from hormone therapy. The old paradigm is in crisis and must now be replaced, but the authors do not specify what we are shifting to and appear unaware of competing paradigms. The relevance of the findings of the WHI and related studies to the "iron hypothesis,"² one of the few proposed alternative paradigms . . . [Full Text of this Article]

AUTHOR INFORMATION
Jerome L. Sullivan, MD, PhD

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