The sound and the fury: was it all worth it?

Abstract

The initial report of coronary heart disease (CHD) results from the trial of menopausal hormone therapy within the Women's Health Initiative precipitated substantial surprise and concern in the epidemiology research community over the apparent differences between the trial results and those of observational studies. What followed was 6 years of discussion and debate, frequently acrimonious, along with intense methodologic and substantive research attempting to reconcile or explain the apparent differences. The results have been an impressive improvement in methods to contrast and combine studies of differing designs, dramatic illustrations of some central epidemiologic principles, insights into likely mechanisms of CHD, and increasing clarity of the public health message about menopausal hormone therapy.