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Hormone Therapy Found To Increase Risk of Heart Attack

Aug 6, 2003 | The Orlando Sentinel Women who take a combination of estrogen and progestin increase their risk of having a heart attack by as much as 81 percent in the first year, and the hormone treatment only should be given to ease severe symptoms of menopause, according to a study released Wednesday.

The report - which builds on research revealed last year that caused sweeping changes in the way hormones are prescribed - confirmed doubts about the therapy's benefits. Another study released Wednesday found that hormones failed to slow clogging of the arteries.

The bottom line: The treatment does not aid the heart as once thought, and it can cause harm.

"If hormone therapy still has a role, it's in the short-term treatment of menopausal symptoms, but it has no remaining role in the prevention of chronic disease, and most importantly, it should not be used to prevent heart disease," said Dr. JoAnn E. Manson, one of the study's lead authors and chief of preventive medicine at Harvard's Brigham and Women's Hospital.

The studies, published in The New England Journal of Medicine, elaborate on the concerns brought to light last year through a research project called the Women's Health Initiative. The study included more than 16,000 women age 50 and older, who were randomly assigned to either take a sugar pill or a commonly prescribed combination of estrogen and progestin.

Researchers discovered that the hormone replacement therapy marketed as Prempro slightly increased the risk of breast cancer, stroke, blood clots and most surprisingly, heart attacks. Earlier studies had suggested that women protected themselves from heart disease by taking hormones, but that assumption was shattered with the new data.

The estrogen-progestin research was halted early, although a separate study is continuing within the Women's Health Initiative to look at the effects of taking estrogen only.

In the months since, other findings have further chipped away at the supposed benefits of estrogen-progestin therapy. It does not protect the mind, as once thought, but instead increases the risk of Alzheimer's and other forms of dementia. It also makes some breast tumors harder to detect, thereby delaying diagnosis and rendering the cancer more difficult to treat after it's found.

In the latest research, Manson and her colleagues studied the heart-attack data from the Womens' Health Initiative more closely and found that women taking hormones increase their risk of heart attack by 81 percent in the first year. The risk drops in time, and overall, women who are on hormones for 5.6 years have a 24 percent increased risk, she said.

Women at greater risk included those who had high cholesterol when they started the therapy.

This should be taken into account when considering hormone therapy to relieve symptoms of menopause, but it doesn't mean women with high cholesterol should steer clear of the therapy completely, Manson said.

"It does mean that they have an even greater risk of heart disease, but we're really not ready to make recommendations based on these findings," she said.

In the second study, doctors found that taking a different formulation of hormone therapy did not slow the clogging of arteries though it did not increase the problem, either. There simply wasn't any benefit from it.

"We were expecting there would be regression, and there wasn't," said Dr. Roger Lobo from Columbia University in New York.

Both studies reinforce the need for women to consider their individual risk factors and weigh them against the severity of their menopausal symptoms, said Dr. Wulf Utian, executive director of the North American Menopause Society.

"It's a discussion that women have to enter into with their doctors on an individual level," Utian said. "But clearly, the thing to keep in mind is there is no reason to panic."

In the past, doctors routinely prescribed hormone therapy to women, who took it indefinitely. But now, they are re-evaluating the therapy regularly with women and weaning them off the therapy if it's no longer needed to treat hot flashes, vaginal dryness and other symptoms of menopause, said Dr. Ashley Hill, director of obstetrics and gynecology in the Florida Hospital family practice residency program.

Hill said women who take the therapy should see their doctors annually for a checkup and continue discussion of the risks. He said many of his patients who stopped using the therapy after the Women's Health Initiative findings last year started again.

"I think of hormone-replacement therapy just as any other medication I prescribe - some are more dangerous than others, and it's up to the patient to decide if the risks are worth treating the symptoms they are having," Hill said.

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