We wanted to use this opportunity to shed light on the discussion on post-menopausal hormone therapy (HT) via highlighting the important yet controversial WHI trial
2/ WHI followed the Nurses' Health Study, a prospective investigation that showed HT was associated with decreased cardiovascular disease (CVD) risk
3/ WHI, a randomized controlled trial (RCT), was believed to mitigate the effects of confounding factors better than cohort studies. WHI, in contrast to the Nurses’ Health Study, showed that HT was associated with a slightly increased risk for CVD among other conditions
4/ However, WHI comes with significant limitations: the study population was older, and HT formulations have since changed.
Newer studies have supported more benefits of HT in younger, healthier, symptomatic women. In this way, WHI has contributed to the underutilization of HT
5/ Long-term follow-up results from newer RCTs investigating HT, including DOPS, KEEPs, and ELITE have shown significant vasomotor symptom alleviation without increased risk of CVD
This led the North American Menopause Society to release their position statement on HT in 2017:
6/ @MenopauseOrg: "For women aged younger than 60 years or who are within 10 years of menopause onset and have no contraindications, the benefit-risk ratio is most favorable for treatment of bothersome vasomotor symptoms and for those at elevated risk for bone loss or fracture."
7/ Thus, our goal of covering the WHI study is to highlight this dynamic escalation in evidence and the importance of the continual pursuit of knowledge throughout the decades
8/ Lastly, we would like to express our tremendous gratitude to all the clinicians and researchers, especially the women leaders of the field, for inspiring this great intellectual journey. Today is for all of you! #IWD2022
Let’s jump in– can you decipher the EKG below to find out what’s wrong with this patient’s His-Purkinje system?
2/ If you thought left anterior fascicular block (LAFB), you were right!
What is the formal criteria for LAFB?!
✅Left axis deviation w/o LVH
✅qR pattern in lead aVL
✅R-peak time in lead aVL of 45 ms or more
✅QRS duration less than 120 ms
3/ Why do our patients get LAFB?!
Think fibrosis in the left anterior fascicle! This causes a slowed electrical conduction → EKG findings.