In Reply: Dr Shah suggests that systematic
reviews of observational studies provide better evidence than single randomized
trials. We disagree strongly. Shah's proposal would, for instance, rank a
meta-analyses of observational studies of hormone replacement therapy1 (which suggested a 50% reduction in relative risk
of coronary events) higher than the Heart and Estrogen/progestin Replacement
Study (HERS) RCT,2 which found no effect
of hormone replacement therapy for secondary prevention of coronary events.
We would rank the HERS RCT higher and, pending further RCT evidence, would
not recommend hormone replacement therapy to women to decrease their risk
of cardiovascular events. When consistent biases exist in observational studies
(such as the tendency for women with lower cardiovascular risk to receive
hormone replacement therapy), a meta-analysis offers no protection.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 3
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.