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The Women's Health Initiative randomized clinical trial of hormone therapyfound no benefit of hormones in preventive cardiovascular disease, a finding instriking contrast with a large body of observational research. Understandingwhether better methodology and/or statistical adjustment might have preventedthe erroneous conclusions of observational research is important. This is are-analysis of data from a case-control study examining the relationship ofpostmenopausal hormone therapy and the risks of myocardial infarction (MI) andischemic stroke in which we reported no overall increase or decrease in therisk of either event. Variables measuring health behavior/lifestyle that arenot likely to be causally with the risks of MI and stroke (e.g., sunscreen use)were included in multivariate analysis along with traditional confounders (age,hypertension, diabetes, smoking, body mass index, ethnicity, education, priorcoronary heart disease for MI and prior stroke/TIA for stroke) to determinewhether adjustment for the health behavior/lifestyle variables could reproduceor bring the results closer to the findings in a large and definitiverandomized clinical trial of hormone therapy, the Women's Health Initiative.For both MI and stroke, measures of health behavior/lifestyle were associatedwith odds ratios (ORs) less than 1.0. Adjustment for traditional cardiovasculardisease confounders did not alter the magnitude of the ORs for MI or stroke.Addition of a subset of these variables selected using stepwise regression tothe final MI or stroke models along with the traditional cardiovascular diseaseconfounders moved the ORs for estrogen and estrogen/progestin use closer tovalues observed in the Women Health Initiative clinical trial, but did notreliably reproduce the clinical trial results for these two endpoints.

Statistical adjustment for a measure of healthy lifestyle doesn't yield the truth about hormone therapy