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Hormone Therapy Found To Be Risky For Women's Hearts

Aug 7, 2003 | Star Ledger

In the final analysis, hormone replacement therapy does not protect women from heart attacks and may actually increase the risk of developing heart disease in the first year of treatment, according to an updated assessment of a major health study.

The combined hormones of progestin and estrogen, prescribed in pill form to women for a decade for the relief of symptoms of menopause, should no longer be prescribed for the prevention of cardiovascular disease, scientists are reporting in today's edition of the New England Journal of Medicine.

The report represents the final word on the effect of hormones on women's hearts, part of a massive federal study known as the Women's Health Initiative, designed to answer fundamental questions about hormones, nutrition and osteoporosis.

"Any way you look at it, the only really good reason to take it is if you have really bad menopausal symptoms that outweigh the increased risk of heart disease and stroke," said Norman Lasser, one of the paper's authors and a professor of medicine at the University of Medicine and Dentistry of New Jersey in Newark. "But that will have to be considered by a woman and her doctor on an individual, case-by-case basis."

For a decade, the belief that hormone replacement therapy not only eased menopausal symptoms but also offered protection against heart disease fueled prescriptions of the drug. That belief was shattered a year ago when scientists halted the Women's Health Initiative study established expressly to prove the beneficial heart-hormone connection after finding that women on the pills were at higher risk of developing heart disease and breast cancer.

The current findings extend the information that has been published previously by including re-analysis and examination of cases that had not been included initially. The study showed that women using hormone replacement therapy are at a 24 percent greater risk of developing heart disease. An initial study placed the risk at 29 percent.

This means that six women out of 10,000 who are taking the therapy would suffer a heart attack, according to Lasser.

In addition, women taking hormone replacement therapy also seemed to suffer most of their heart attacks in the first year of treatment. As a group, women on the therapy were at an 81 percent greater risk of suffering a heart attack in the first year of therapy. By the sixth year, the increase in risk is minimal compared with the group not taking therapy, the study showed.

Authors of the study, 15 scientists from medical schools across the country, scoured the data to see if they could tell which women were at greatest risk of having a heart attack. They examined differences such as the age of the onset of menopause or whether a woman experienced any hot flashes as factors and could not come up with a common thread that could explain the reaction.

For years, conventional medical wisdom asserted that replacing the estrogen lost after menopause protected against heart disease because the treatment often lowered the "bad" cholesterol levels and increased the amount of the "good" cholesterol."

Even when studies, beginning in 1998, revealed there was no benefit, the belief was so ingrained the findings were heavily criticized and dismissed, said David Herrington and Timothy Howard of the Wake Forest University School of Medicine, writing an analysis in the journal.

Much of the belief that hormone replacement therapy protected against heart disease was gleaned from so-called observational studies, where patients fill out questionnaires about their behavior but are not as closely monitored as in clinical trials.

"There was a suggestion from these studies that it could be, but we now know that that protection no longer exists," said Natalie de Vane, a spokesperson for Wyeth Pharmaceuticals, a division of Wyeth in Madison. The company makes Prempro, the country's most popular combination hormone therapy.

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