emia, 4.4 percent were being treated for diabetes,and 10.5 percent were current smokers) were con-sistent with those in a generally healthy populationof postmenopausal women.follow-up and adherenceVital status was known for 16,067 women who un-derwent randomization (96.7 percent), including485 (2.9 percent) who were known to be deceased.Information on outcomes was up to date for 15,582women (93.8 percent); for the 541 women (3.3 per-cent) who were lost to follow-up or who stoppedproviding information on outcomes before the tri-al ended, we include all available information. Thepresent report updates information on outcomesthrough July 7, 2002 (after an average of 5.6 years offollow-up [as compared with 5.2 years in the earlierreport8] and a maximum of 8.6 years). As previouslyreported,842 percent of women randomly assignedto estrogen plus progestin and 38 percent of womenrandomly assigned to placebo stopped taking thestudy drugs during follow-up — rates that comparefavorably with community-based adherence to hor-mone therapy.20The cumulative “drop-in” rate —the rate of hormone use initiated by the woman’sclinician — was 6.2 percent in the estrogen-plus-progestin group and 10.7 percent in the placebogroup by year 6.intermediate biomarkers and risk factors for chdThe results of assessments of CHD biomarkers, in-cluding fasting blood lipid, glucose, and insulin lev-els, in an 8.6 percent subsample of women at baseline and at year 1 are shown in Figure 1. Womenrandomly assigned to estrogen plus progestin hadgreater reductions in the total cholesterol, low-den-sity lipoprotein (LDL) cholesterol, glucose, and in-sulin levels and greater increases in the high-densityFigure 1. Differences between the Mean Percent Changes from Base Line to Year 1 in Several Intermediate Outcomes in the Estrogen-plus-Progestin Group as Compared with the Placebo Group.Horizontal lines represent the 95 percent confidence intervals. The differences between the groups were significant (P<0.05) for total choles-terol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, glucose, systolic blood pressure, weight, and waist circumference.Mean Percent Change from Base Line in the Estrogen-plus-Progestin Groupminus Mean Percent Change in the Placebo GroupTotal cholesterolLDL cholesterolHDL cholesterolTriglyceridesGlucoseInsulinSystolic blood pressureDiastolic blood pressureWeightWaist circumferenceWaist-to-hip ratio¡15109876543210¡1¡2¡3¡4¡5¡6¡7¡8¡9¡10¡11¡1413¡1211–5.4–12.7–18.104.22.168.9–7.1–0.1–0.4–0.9–0.2The New England Journal of Medicine Downloaded from nejm.org at ST LOUIS UNIVERSITY on October 13, 2015. For personal use only. No other uses without permission. Copyright © 2003 Massachusetts Medical Society. All rights reserved.
n engl j med 349;6august 7, 2003estrogen plus progestin and the risk of coronary heart disease527lipoprotein (HDL) cholesterol and triglyceride lev-els than women in the placebo group. Systolic blood
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