The ELITE trial compared early versus late initiation of oestrogen therapy after menopause for cardiovascular outcomes. What was its KEY finding relevant to the 'timing hypothesis'?

• A Late initiation of HRT (>10 years after menopause) was associated with significant cardiac protection
• B Combined oestrogen-progestogen therapy was superior to oestrogen alone at any timing
• C Oestradiol therapy initiated within 6 years of menopause slowed carotid intima-media thickness progression; later initiation (>10 years) had no benefit ✓
• D Timing of initiation had no effect; all benefits were seen in symptomatic women only

Explanation

The ELITE (Early versus Late Intervention Trial with Estradiol) study, published in NEJM 2016, randomised women to oral oestradiol within 6 years versus >10 years of menopause. Early initiators showed significantly slower carotid artery intima-media thickness progression (a surrogate for atherosclerosis) and lower coronary artery calcium scores, supporting the 'timing hypothesis' (also called the 'window of opportunity') — oestrogen is cardioprotective when started close to menopause but potentially harmful or neutral when started late. This supports early initiation for maximum benefit.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.