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Biomedical subjects

Harold C Sox

Publications and source records attributed to Harold C Sox.

9 recordsLinked to original sources
PubMed2002

Postmenopausal hormone replacement therapy and the primary prevention of cardiovascular disease.

PURPOSE: To evaluate the value of hormone replacement therapy (HRT) in the primary prevention of cardiovascular disease (CVD) and coronary artery disease (CAD). DATA SOURCES: MEDLINE and Cochrane databases were searched for all primary prevention studies reporting CVD or CAD incidence, mortality, or both in association with HRT; reference lists, letters, editorials, and reviews were also reviewed. DATA EXTRACTION: All studies were reviewed, abstracted, and rated for quality. STUDY SELECTION: Only studies of good or fair quality, according to U.S. Preventive Services Task Force (USPSTF) criteria, were included in the detailed review and meta-analysis. DATA SYNTHESIS: The summary relative risk with any HRT use was 0.75 (95% credible interval [CrI], 0.42 to 1.23) for CVD mortality and 0.74 (CrI, 0.36 to 1.45) for CAD mortality. The summary relative risk with any use was 1.28 (CrI, 0.86 to 2.00) for CVD incidence and 0.87 (CrI, 0.62 to 1.21) for CAD incidence. Further analysis of studies adjusting for socioeconomic status, as well as other major CAD risk factors, showed a summary relative risk of 1.07 (CrI, 0.79 to 1.48) for CAD incidence associated with any HRT use. Similar results were found when the analysis was stratified by studies adjusting for alcohol consumption, exercise, or both, in addition to other major risk factors, suggesting confounding by these factors. CONCLUSIONS: This meta-analysis differs from previous meta-analyses by evaluating potential explanatory variables of the relationship between HRT, CVD, and CAD. The adjusted meta-analysis is consistent with recent randomized trials that have shown no benefit in the secondary or primary prevention of CVD events. A valid answer to the role of HRT in the primary prevention of CVD will best come from randomized, controlled trials.

Cardiovascular Diseases↗
PubMed2002

Chemoprevention of breast cancer: a summary of the evidence for the U.S. Preventive Services Task Force.

PURPOSE: Chemoprevention offers promise as a strategy for reducing morbidity and mortality from breast cancer in women. This review examined the evidence for the effectiveness of chemoprevention in women without a history of breast cancer. DATA SOURCES: MEDLINE (1966 to December 2001). STUDY SELECTION: English-language, randomized, controlled trials (RCTs) of chemoprevention of breast cancer in women without a previous diagnosis of breast cancer were examined, and 4 relevant trials, 3 involving tamoxifen and 1 involving raloxifene, were selected. Trials that provided data on the harms of tamoxifen or raloxifene, studies of the costs of chemoprevention, and studies of risk assessment were also reviewed. DATA EXTRACTION: Four reviewers independently abstracted data on key variables, including study population, sample size, randomization, treatment, and outcomes. DATA SYNTHESIS: The largest of the RCTs of tamoxifen reported a 49% reduction in relative risk (0.51 [95% CI, 0.39 to 0.66]) for invasive cancer among women with an estimated 5-year breast cancer risk of at least 1.66%. The other tamoxifen trials did not observe a statistically significant benefit, but only a few women in each trial took tamoxifen during the entire study period. The raloxifene study of postmenopausal women with osteoporosis found a 76% reduction in relative risk (0.24 [CI, 0.13 to 0.44]) for invasive breast cancer. Tamoxifen and raloxifene were effective only against estrogen receptor-positive tumors. Both drugs increased risk for venous thromboembolic disease and hot flashes; tamoxifen increased risk for endometrial cancer and stroke. CONCLUSIONS: Tamoxifen and raloxifene reduce the incidence of estrogen receptor-positive breast cancer in women. The relative risk reduction seems similar across all breast cancer risk groups. The absolute risk reduction varies by risk factors for breast cancer, however, and must be balanced against the potential harms to judge the appropriateness of treatment for individual women.

Anticarcinogenic Agents↗