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Tuesday, November 1, 2022

Biden scrambles to paint misleading picture of economy one week from the midterms

 President Biden and White House officials have frantically scrambled to downplay Americans' economic concerns on inflation and gas prices as the midterm election quickly approaches.

Over the last few weeks, the White House has suggested the U.S. is in the midst of a "historic" economic recovery, that the narrative gas prices are high is false and that the economy is set for a "soft land," not a recession.

Biden and his top advisers have also touted Democrats' big-spending packages on infrastructure and climate as key measures boosting economic productivity and blunting record price increases.

"Today we got further evidence that our economic recovery is continuing to power forward," Biden said in a statement on Thursday after the Department of Commerce published a key economic report. "This is a testament to the resilience of the American people. As I have said before, it is never a good bet to bet against the American people."

"Even with our historic economic recovery, gas prices are falling – down $1.26 since the summer, and down over the last three weeks," he continued.

The Commerce Department report Thursday showed U.S. gross domestic product (GDP) increased at an annualized rate of 2.6% during the third quarter, the period from July to September. The GDP had shown negative growth during the first two quarters of the year.

Also in response to the report, Ron Klain, the White House chief of staff, retweeted a post from Mark Zandi, an economist at the firm Moody's Analytics, who argued the GDP growth was evidence a recession was less likely.

"Last week’s data suggest that the economy is on script to soft land. GDP posted a solid gain in Q3, further dispelling concerns we have suffered a recession," Zandi wrote. "And while GDP has gone nowhere this year despite the Q3 gain, that’s what’s needed to quell inflation without a recession."

Biden also told reporters the economy is "strong as hell" and downplayed inflation concerns when speaking to reporters on Oct. 16. A week later, Klain characterized economic concerns as "noise."

However, many economists, including a majority recently surveyed by the National Association for Business Economics, believe the U.S. has already entered a recession or will likely soon enter a recession. And economists polled by The Wall Street Journal in mid-October said there was a 63% chance of a recession within the next 12 months.

Economists argued the positive GDP numbers Thursday signaled poor economic conditions.

"Conditions continue to deteriorate and all the indicators that I follow are pointing in the wrong direction," Heritage Foundation research fellow E.J. Antoni told FOX Business in an interview.

"The idea of a soft landing is complete nonsense at this point," he continued. "If you look at, for example, new orders, they continue to deteriorate. The latest report was out of the Texas Federal Reserve this morning and that shows, again, that new orders continue to deteriorate. So, businesses are working through backlogs from the pandemic and as soon as that's gone, the party's over."

Antoni noted that the GDP report last week was only positive due to a temporary spike in net exports. He said the figure was driven higher because Americans are consuming less due to higher prices and, therefore, importing fewer goods.

"I would say the Biden administration's talking point on the economy is ‘never let the facts get in the way of their political spin.’ It is absolutely astounding how they can proclaim one thing from the podium when Americans are feeling the exact opposite," Antoni added.

In addition, the White House has cheered gas price declines and Biden falsely said last week that the average price of gasoline when he entered office was $5 per gallon.

However, the average price of gasoline nationwide was $2.39 a gallon on Jan. 25, 2021, roughly 48% of what Biden claimed it was, according to the Energy Information Administration. The current average pump price nationwide sits at $3.76 per gallon, 57% higher than when Biden took office, according to AAA data.

The president, though, has largely blamed gas price increases on Russia's invasion of Ukraine and Middle Eastern nations' decision to cut back on oil production. Antoni argued gas prices would be lower if Biden had pursued former President Trump's policies on energy production.

"I would love to know how Russia canceled construction of American pipelines or how Russia raised taxes on American oil and gas producers," he told FOX Business. "Or how Russia prevented drilling leases on American federal lands. All of that was done by the Biden administration and all of that has driven up prices."

Finally, the White House has sought to also paint Republicans as extreme ahead of the election. For example, Biden has argued that Republicans are "coming after Social Security" and Medicare.

But the comments, which are based on a plan set forth by Sen. Rick Scott, R-Fla., mischaracterize GOP economic plans. Scott and other top Republican lawmakers have denied they want to end the popular welfare programs.

"No one that I know of wants to sunset Medicare or Social Security, but what we’re doing is we don’t even talk about it," Scott recently said. 

"Medicare goes bankrupt in four years. Social Security goes bankrupt in 12 years. I think we ought to figure out how we preserve those programs. Every program that we care about, we ought to stop and take the time to preserve those programs."

One week from the midterm elections set for Nov. 8, the economy, inflation and gas prices continue to be major concerns for voters.

https://www.foxbusiness.com/politics/biden-scrambles-paint-misleading-picture-economy-one-week-midterms

Myriad misses, cuts guidance

 

  • Revenue of $156.4 million for the quarter ended September 30, 2022.

    • Third quarter revenue, excluding divested businesses, was impacted by currency translations ($3.3 million), change of estimates1 ($5.3 million).

    • Third quarter testing volumes, excluding divested businesses, grew 12% year-over-year. Hereditary cancer testing volume continued to improve in 2022 and grew 4% year-over-year in the third quarter. GeneSight volumes grew 34% over third quarter of 2021.

    • We believe that the underlying pricing of Myriad testing products remains stable, notwithstanding that average selling price overall was negatively impacted by currency translations, change of estimates and a non-recurring milestone payment in the third quarter.

  • Diluted GAAP earnings per share (EPS) were $(0.43) and adjusted EPS were $(0.19) in the third quarter of 2022.

  • Molecular Diagnostic Services Program (MolDX®) assigned the MyRisk® hereditary cancer test Current Procedural Terminology (CPT) code 81479 and assigned favorable test specific pricing.

  • Acquired Gateway Genomics, LLC, a leading private developer of consumer genetic tests serving the women’s health market for $67.5 million cash and up to an additional $32.5 million of cash consideration upon achievement of certain revenue, volume and earnings-based targets over 2023 and 2024.

  • Updated full year 2022 financial guidance to reflect third quarter business updates.

  • Conference call today at 4:30pm ET; slide presentation available now at www.myriad.com.

A conference call will be held today, Tuesday, November 1, 2022, at 4:30 p.m. EDT to discuss Myriad Genetics’ financial results and business developments for the third quarter 2022. The dial-in number for domestic callers is 1-800-954-0689. International callers may dial 1-212-231-2937. All callers will be asked to reference reservation number 22021060. An archived replay of the call will be available for seven days by dialing 1-800-954-0689 and entering the reservation number above. The conference call and slide presentation will be available through a live webcast at www.myriad.com.

Gum Disease-Afib Link Deepened by Histologic Findings

 Growing evidence suggests periodontitis as a possible modifiable risk factor for atrial fibrillation (Afib), though left unanswered is the question of whether improving oral health can help clinical outcomes.

A histologic association between inflammatory gum disease and atrial fibrosis was confirmed in a small prospective study showing that people exhibiting signs of periodontitis -- bleeding on probing, periodontal probing depth 4 mm or deeper, and greater periodontal inflamed surface area (PISA) -- tended to have atrial fibrosis based on their resected left atrial appendages (LAAs).

PISA was significantly associated with atrial fibrosis after multivariable adjustment.

With fibrotic replacement of atrial myocardium known to contribute to the development of Afib, these findings add to the evidence for a link between oral and systemic disease, according to Yukiko Nakano, MD, PhD, of Hiroshima University in Japan, and colleagues.

"This study provides basic evidence that periodontitis can aggravates [sic] atrial fibrosis and thus leads to the onset and persistence of Afib," they stated in JACC: Clinical Electrophysiology. "Further prospective clinical studies are warranted to clarify whether periodontal intervention alone can inhibit atrial fibrosis and improve Afib outcome." The findings are slated for inclusion at the 2022 American Heart Association annual meeting.

"Studies are now warranted to show that treatment of chronic periodontitis is atrial protective," agreed Andreas Goette, MD, of St. Vincenz Hospital in Paderborn, Germany, in an accompanying editorial.

There are decades of research linking oral infections with conditions such as diabetes mellitus, atherosclerosis, cardiovascular and cerebrovascular diseases, and rheumatoid arthritis. What Nakano and colleagues have done is "add a small piece in the puzzle to understand the role of chronic inflammation in the development of atrial fibrosis, Afib, and stroke," Goette commented.

"Importantly, about 50% of the middle-aged population is affected by different stages of periodontitis. Thus, it is of potential clinical importance to assess if chronic oral inflammatory processes may contribute to the development of atrial pathologies," Goette said.

The prospective study included 76 people with Afib (mean age 71.1, 63% men) scheduled to undergo LAA excision during cardiac surgery. All underwent an oral examination in the 3 days before surgery and the degree of fibrosis in each LAA was quantified by Azan-Mallory staining.

Degree of atrial fibrosis correlated with the patient's Afib duration, Nakano's group reported.

Atrial fibrosis was significantly more common in patients with nonparoxysmal Afib than in patients with paroxysmal Afib. Likewise, PISA was significantly greater in patients with nonparoxysmal Afib.

Patients with a LAA thrombus had significantly higher PISA than did those without.

"It is tempting to speculate that the increasing incidence of Afib in the world is at least to some extent related to oral infections, which could be an easy therapeutic target for primary prevention of Afib and stroke in the overall population," Goette said.

However, the study was limited by its small sample size. Additionally, the observational design precluded any causal finding between inflammatory gum disease and atrial fibrosis; based on the data, it's possible that periodontitis reflects poor self-care by the patient, according to the authors.

Also unclear are the molecular mechanisms that would link periodontitis and atrial fibrosis, Goette noted.

"Furthermore, it is unclear whether the release of inflammatory markers around infected teeth and oral tissue into the systemic circulation directly causes atrial changes or if the immune response induced by periodontitis causes via activation several secondary factors activation of fibroblast," he wrote.


Disclosures

The study was funded by Japan Society for the Promotion of Science grants.

Nakano and co-authors disclosed no relationships with industry.

The editorial was supported by a European Union grant. Goette disclosed relationships with Abbott, AstraZeneca, Bayer Health Care, Berlin Chemie, Biotronik, Boehringer Ingelheim, BMS/Pfizer, Boston Scientific, Daiichi Sankyo, Medtronic, Omeicos, and Sanofi.

Can First MS Symptoms Be Delayed?

 Dimethyl fumarate (Tecfidera) reduced the risk of the first symptom manifestation of multiple sclerosis (MS) in people with radiologically isolated syndrome (RIS), data from the ARISE trial showed.

The risk of a first clinical demyelinating event over 96 weeks was reduced both in unadjusted (HR 0.18, 95% CI 0.05-0.63, P=0.007) and adjusted (HR 0.07, 95% CI 0.01-0.45, P=0.005) models with dimethyl fumarate treatment, reported Darin Okuda, MD, of the University of Texas Southwestern Medical Center in Dallas.

"This is the first clinical trial that really demonstrated the benefit of a given disease-modifying therapy in preventing a first acute clinical event in people with RIS," Okuda said in a late-breaking presentation at the 2022 meeting of the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS).

The findings support the benefit of early intervention in the MS disease spectrum, Okuda observed. "In the future, we'd like to see further studies be performed to assess the impact on disability outcome measures following treatment for a meaningful amount of time," he added.

RIS represents the earliest detectable preclinical phase of MS. "Such individuals possess incidental anomalies, highly suggestive of multiple sclerosis, yet they lack typical symptoms and structural findings differ greatly from those seen in nonspecific white matter disease," Okuda noted.

The trial recruited people with RIS from March 2016 to October 2019 at 12 U.S. sites, randomizing 87 participants to dimethyl fumarate (44 people) or placebo (43 people).

"We leveraged two independent committees for this study," Okuda stated. "Both committees evaluated clinical data and imaging data through adjudicated consensus, and if screening was successful, patients were randomized one-to-one to receive dimethyl fumarate in accordance with the FDA-approved label or placebo."

Formal clinical assessments were acquired at weeks 0, 48, 96, and at the time of a first clinical event. MRI scans were performed at weeks 0 and 96. "Ten of 87 individuals did not complete the full 96 weeks as the study was prematurely terminated by the study sponsor; the reason for that was because of the slow pace of recruitment," Okuda pointed out.

At baseline, mean ages were 43.6 in the treatment group and 44.8 in the placebo group. Both groups had 70% females and baseline Expanded Disability Status Scale (EDSS) scores of 1 on a scale of 0 to 10. Nearly 90% of participants were white.

In the dimethyl fumarate group, six of 38 people had gadolinium-enhancing lesions at baseline; in the placebo group, two of 28 people did.

Adjusting for the number of gadolinium-enhancing lesions at baseline, there were fewer new or newly-enlarging T2-weighted hyperintense lesions in the dimethyl fumarate group compared with placebo (HR 0.20, 95% CI 0.04-0.94, P=0.042). Gadolinium enhancement was present in only one participant at week 96.

More moderate adverse reactions emerged in the dimethyl fumarate group (32%) than placebo (21%) but severe events were similar (5% vs. 9%, respectively). "We did not see anything remarkable with respect to adverse reactions," Okuda noted.

In a discussion after the presentation, Mark Freedman, MD, MSc, of the University of Ottawa in Canada, asked what percentage of participants had cervical cord lesions and whether those patients were more like to convert.

"Unfortunately, due to restrictions in funding, we weren't able to acquire spinal cord imaging in a well-organized, uniform manner," Okuda said.

"We haven't looked at our data in that way because not everyone actually had spinal cord imaging," he added. "We understand that this is one potential limitation for our study, in that there may have been an imbalance between groups in terms of who had spinal cord lesions."


Disclosures

The study was funded by Biogen.

Okuda disclosed support from, and/or relationships with, Biogen and EMD Serono/Merck, Alexion, EMD Serono, Genzyme, Novartis, RVL Pharmaceuticals, TG Therapeutics, Viela Bio, Celgene/Bristol Myers Squibb, Genentech, Janssen Pharmaceuticals, and Osmotica Pharmaceuticals.

'Don't Normalize Depression in Older Adults'

 Depression should not be considered a normal part of aging and should never be taken lightly. Feeling sad is a common reaction to loss, life struggles, or weakened self-esteem, but when those feelings become overwhelming, cause physical symptoms, or impact daily functioning, they prevent one from living a fulfilling life.

The prevalence of clinical depression in aging seniors can't be ignored, nor can the added barriers to behavioral healthcare in senior living facilities. Access to high-quality, comprehensive, and convenient depression treatment should be available to all residents of skilled nursing and assisted living facilities, and this care should be normalized for those facing hardship.

Mental Health and Seniors: Why the Stigma?

The stigma preventing mental health intervention in seniors needs to be resolved -- both among the older population as well as healthcare providers. The generation of seniors today grew up during a time when the stigma around mental health was even greater than it is now. Turning a blind eye to mental health has been ingrained in them for decades. Even as the topic becomes more mainstream and accepted, older populations may be more resistant to the idea.

On the other side, the aging population with depression is often misunderstood and abandoned by the healthcare system. Depression in the senior population tends to differ from younger generations because of their more common preexisting physical health problems. These ailments may provoke depression and overshadow it when being diagnosed.

The stigma of mental health issues in seniors deprives them of their right to well-being and reinforces patterns of hopelessness and isolation. Senior care professionals need more effective training processes with a greater focus on how to manage depressive health alongside physical issues. More belief in and access to care and treatment plans for depressed, aging adults will lead to more desirable health outcomes, patient and loved one satisfaction, and a higher quality of life.

Comprehensive Treatment Options

With the population of older adults in the U.S. projected to increase from 56 million to 94.7 million through 2060, it's important to understand how to identify and treat symptoms of depression effectively in this group. As with all psychiatric care, patients and their families need to feel engaged with providers and be informed of safe treatment options and therapies to reduce the symptoms of depression.

Treating depression in senior living facilities should be comprehensive -- not a one-method approach -- that combines psychotherapy and medication (if needed). While patients are often prescribed medications, such as benzodiazepines, to combat symptoms, many would benefit from non-pharmacological interventions as the first line of treatment.

Just as with younger patients, a psychotherapy approach uses talk therapy to treat depression. Different types of psychotherapy can be effective for depression in seniors, such as cognitive behavioral therapy or interpersonal therapy, and are just as effective to:

  • Identify negative beliefs, behaviors, and issues that contribute to the depression, then replace them with positive ones
  • Explore relationships and experiences, and develop positive interactions with others
  • Regain a sense of satisfaction and control later in life and help ease depression symptoms, such as hopelessness and anger
  • Develop the ability to tolerate and accept distress using healthier behaviors; behavior change is possible, even in seniors
Alleviating Barriers to Depression Care

Research from the University of Rochester School of Medicine and Dentistry shows that up to 30% of nursing home residents experience minor or major depression, but approximately that same percentage (20% to 40%) of nursing facilities nationwide say providing basic behavioral health services is "difficult" or "very difficult." Too many older adults are falling through the cracks.

Care access barriers are greater for older age groups in part due to their limited mobility and short supply of mental health providers who specialize in depression care for seniors, especially in rural areas. Those with mobility challenges may worry about packing up to leave the community and wonder if the doctor's office is accessible to their physical limitations. This can add more stress if the senior is experiencing apathy or amotivation. All this makes it especially difficult to pursue treatment outside the community and ask for help.

Whether it's situational or clinical depression, staffing shortages, prolonged wait times, quarantine regulations, and transportation issues all inhibit the ability to treat patients properly. The pandemic escalated the need for federal approval of telehealth appointments, and emphasized their value in improving care access, especially among the aging population. More mediums must become available for seniors to address their behavioral health.

Expanded access to telehealth is one viable option. Offering behavioral health services from a remote location can lead to better patient outcomes if they have the option to stay in an environment that's conducive to their needs. Patients feel more comfortable because sessions are conducted in a familiar setting, and it eliminates the hassle of securing transportation and traveling to a doctor's office. Appointments are made digitally and facilitated remotely, adding an extra layer of privacy for the resident. They also feel more secure seeing the doctor online because they are surrounded by their belongings and in their own space, which may help them dive deeper into their challenges and lead to workable solutions sooner.

Depression Treatment Delivery for the Future

Despite progress over the last several years, the stigma of depression and psychotherapy for today's aging adults still exists. The added stress of the COVID-19 pandemic led seniors to experience isolation like never before. The industry is quickly realizing how innovative ways to deliver depression care is the disruptive force needed for caregivers to reach older adults effectively.

The future of treatment delivery for mental healthcare is bright. Functional access to depression care is the cultural shift needed in the senior care industry, and telehealth is one medium lighting the way.

Sherie Friedrich, PsyD, is chief psychology officer at MediTelecare, a company providing behavioral telemedicine services to residents of skilled nursing and assisted living facilities.

https://www.medpagetoday.com/opinion/second-opinions/101498

1 in 8 U.S. Adult Deaths Involved Too Much Booze

 One out of every eight deaths in Americans ages 20 to 64 resulted from drinking too much alcohol, according to a U.S. population-based study.

Nationally, 12.9% of total deaths per year among adults in this age group were attributed to excessive alcohol consumption from 2015 to 2019, and that number rose to 20.3% of total deaths per year when restricted to people ages 20 to 49, reported Marissa Esser, PhD, MPH, of the CDC in Atlanta, and colleagues.

Alcohol-attributed deaths ranged from 9.3% in Mississippi to 21.7% in New Mexico and were more common among men than women (15% vs 9.4%), the authors wrote in JAMA Network Open.

"These premature deaths could be reduced through increased implementation of evidence-based alcohol policies (e.g., increasing alcohol taxes, regulating alcohol outlet density), and alcohol screening and brief intervention," the authors concluded.

Alcohol consumption remains a leading preventable cause of premature death, with rates rising for alcoholic liver disease among young adults up to age 64, Esser's group noted. A prior CDC report from 2006 to 2019 attributed one in 10 deaths to excessive alcohol consumption among adults ages 20 to 64, but it was largely based on self-reported data without consideration of per capita alcohol sales.

"Compared with 2019, death rates involving alcohol as an underlying or contributing cause of death increased during the first year of the COVID-19 pandemic in 2020, including among adults aged 20 to 64 years," Esser's group wrote. "Therefore, the proportion of deaths due to excessive drinking among total deaths might be higher than reported in this study."

However, researchers added that their findings were in line with the epidemiology of excessive drinking. Other studies have shown deaths related to alcohol use disorder continued to rise from 2020 to 2021, while pandemic drinking took a toll on the gut and liver.

"Other studies have highlighted the number of deaths from causes that are fully attributable to alcohol use (e.g., alcohol poisoning, alcohol dependence, alcoholic liver disease), but that doesn't capture the full burden of alcohol-related deaths," Esser said. "This study is a comprehensive assessment that includes causes of deaths that are 100% related to alcohol and those that are partially related to alcohol, such as cancer and injuries."

For this population-based study, Esser and colleagues examined data on 2,089,287 participants who responded to surveys on alcohol consumption from the Behavioral Risk Factor Surveillance System from 2015 through 2019. To correct for underreporting, mean daily alcohol consumption was adjusted to 73% of national per capita alcohol sales. Acute partially alcohol-attributable deaths, such as from cancer, were assessed by alcohol-attributed fractions in accordance with blood alcohol concentrations.

The CDC's alcohol-related disease impact application was used to define alcohol-attributed deaths for 58 causes, while mortality data came from the National Vital Statistics System's WONDER database.

Of the 140,557 mean annual deaths attributed to excessive alcohol (5% of total deaths nationally), 89,697 were individuals ages 20 to 64, or nearly two-thirds of the deaths, the researchers noted.

Although the number of alcohol-attributed deaths per 100,000 increased across age groups, those deaths comprised a larger proportion of total deaths for adults ages 20 to 34 (25.4%) compared with those ages 35 to 49 (17.5%). In the younger group, alcohol-attributed deaths were most frequently "other" poisonings (28%), followed by motor vehicle crashes and homicides (24% and 20%, respectively). For those ages 35 to 49 years, the leading cause was poisonings (24%), followed by alcoholic liver disease and motor vehicle crashes (18% and 12%).

The authors acknowledged limitations to the data. Alcohol-attributed deaths may also be conservative estimates since they were based on alcohol-related conditions that were identified only as the cause of death and excluded any contributing causes of death. Alcohol-attributed deaths that were partially caused by alcohol-related conditions were not assessed in those who formerly consumed excessive alcohol.


Disclosures

This study was partially supported by the CDC.

Esser disclosed no conflicts of interest.

Coauthors reported funding from the CDC/HHS.

USPSTF: No Hormone Therapy to Prevent Chronic Conditions After Menopause

 Steer clear of offering hormone therapy as primary prevention for chronic conditions, the U.S. Preventive Services Task Force (USPSTF) advised in an update to its 2017 recommendation.

After reviewing new evidence, the Task Force felt with "moderate certainty" that the use of combined estrogen and progestin has no net benefit for the primary prevention of chronic conditions in postmenopausal people (grade D recommendation), reported Carol Mangione, MD, MSPH, of the University of California Los Angeles, and colleagues in JAMA.

Also in line with the 2017 recommendations, the Task Force recommended against the use of estrogen alone for the primary prevention of chronic conditions in postmenopausal persons who have had a hysterectomy (grade D recommendation).

The updated guideline is largely congruent with those from several other medical organizations, including the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, and the North American Menopause Society.

Instead of hormone therapy (oral or transdermal), the USPSTF said to reference their other prior recommendations on how to prevent cardiovascular disease and other chronic conditions in adulthood. Regular screenings are a common prevention strategy, the group suggested, including screening for breast cancer, colorectal cancer, osteoporosis, high blood pressure, plus prediabetes and type 2 diabetes.

Although the incidence of many of these conditions increases with age, the Task Force pointed out that the average American who reaches menopause at the median age of 51.3 is still expected to live another 30 years.

The updated recommendations only apply to asymptomatic postmenopausal individuals considering hormone therapy to prevent chronic conditions and not for those who experienced premature menopause due to primary ovarian insufficiency or surgically induced menopause. They also don't apply to women who are trying to manage menopause-related symptoms like hot flashes.

This is an important distinction because "despite the efforts of the USPSTF to draw a clear distinction between MHT [menopausal hormone therapy] for prevention vs symptom management, many patients and clinicians conflate these two different indications," wrote Alison J. Huang, MD, MAS, and Deborah Grady, MD, MPH, both of the University of California San Francisco, in an accompanying editorial.

"The notion that 'the net harms of MHT outweigh the benefits,' originally intended to explain the limitations of MHT for routine prevention, is now widely adopted as a rationale for forgoing MHT for symptomatic treatment," they explained.

Huang and Grady said that instead of confirming yet again that hormone therapy shouldn't be used for chronic condition prevention, the USPSTF should instead shift its focus toward developing guidance on which menopausal patients would benefit from this therapy for symptom prevention.

"No longer should patients use hormones to stave off the multidimensional consequences of natural menopause or aging," Huang and Grady stated. "But neither should they be frightened away from considering using MHT for distressing symptoms that emerge in midlife or reflexively urged to use other pharmacologic therapies that, realistically, are also likely to have long-term tradeoffs."

The update was based on a systematic review of 21 randomized clinical trials and three cohort studies. According to studies looking at individuals using estrogen plus progestin compared with placebo, there was a significantly lower risk seen for colorectal cancer over 5.6 years, diabetes over 5.6 years, and fractures over 5 years. However, this was offset by a significantly higher risk for other conditions, such as invasive breast cancer, gallbladder disease, stroke, venous thromboembolism (VTE), probable dementia, and urinary incontinence.

Following a similar pattern, those using estrogen alone also saw a significantly lower risk for developing diabetes and fractures over a 7-year follow-up. The harms also outweighed the benefits with estrogen-only therapy, as there was a significantly greater risk for developing gallbladder disease, stroke, VTE, and urinary incontinence.


Disclosures