Article
Is it possible to demonstrate the risk of hormone replacement therapy regarding cardiovascular disease with secondary data from a health insurance
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Authors
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Cornelia Gerdau-Heitmann
- Zentrum für Sozialpolitik, Universität Bremen, Germany
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Katrin Janhsen
- FG Pharmakologie und Toxikologie, Universität Osnabrück, Germany
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Gerd Glaeske
- Zentrum für Sozialpolitik, Universität Bremen, Germany
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Martina Dören
- Klinisches Forschungszentrum Frauengesundheit, Charité-Universitätsmedizin Berlin, Germany
| Published: | November 22, 2010 |
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Outline
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Introduction: The Nurses Health Study and other observational studies found in the 1990s that Hormone Therapy (HT) seems to reduce the risk of coronary heart disease (CHD). These results led to a widespread use of HT despite the risks (Tannen et al. 2008). Clinical trials like the Women Health Initiative (WHI in 2002) and the Heart and Estrogen/progestin Replacement Study (HERS in 2003) showed that the risk of CHD increased by HT. The aim of this study was to clarify if it is possible to find an increased risk for CHD by using secondary data of a German health insurance.
Methods: For the following analysis secondary data of the Gmünder ErsatzKasse (GEK) was used (time period 2000–2008). This data was related to individuals but non-identifying. The choice of the medicals that were taken into consideration were in accordance with the ATC-Code (ATC=Anatomical Therapeutic Chemical Code). Outpatient data was used to identify patients with CHD like Acute Myocardinfarction (MI), Cerebrovascular Accident (CVA) or Transient Ischemic Attack (TIA) by using ICD-9 and ICD-10. Only data of women who were in 2000 between 50 and 79 years of age and had no HT or CHD in 2000 were taken into account. The analysis was done by using SAS Statistic program.
Results: 109.375 women were insured at the GEK and between 50 and 79 years of age in 2000. In total 49.174 women had to be excluded from the study because of CHD or HT, drop out or use of antithrombotic medicals (except Heparin) in 2000. From the 60.201 included women 3.586 women had a diagnose of CHD and 14.479 women startet with a HT. The odds ratios were significantly reduced for all CHD and HT OR=0.041 (KI 95% 0.032–0.053).
Discussion and conclusion: The used data and study design are not able to show an increased risk regading HT and CHD. These results should not be interpretated that HT prevent CHD because the used data are limited and the development of CHD is multifactoriel. A potential explaination could be a bias due to „survival of the fittest“ or „healthy women bias“.
