Originally created 07/24/01

Hormone replacement therapy not recommended

Don't start hormone replacement therapy just to protect your heart.

That's the advice issued to post menopausal women by the American Heart Association in light of recent studies that have cast doubt on the therapy's benefits.

More than 50 million American women are over age 50 now, and another 40 million are expected to go through menopause in the next 20 years, putting more women than ever in a position to have to decide about the treatments.

Until recently, studies have suggested that taking estrogen after menopause helped reduce the risk of heart disease by as much as 25 percent. But most of the research was based on studies that actually looked at other health issues and also noted whether the women were using hormone replacement therapy. Most of the women in those studies were relatively healthy with a low risk of heart disease.

More recent research involving women with a history of heart disease showed no overall reduction in heart attack risk.

"For many years, cardiologists and other health care providers who take care of women have assumed that HRT protects the heart. At this time, there is not sufficient evidence to make that claim," said Dr. Lori Mosca, director of preventive cardiology at New York Presbyterian Hospital of Columbia and Cornell universities and lead author of the science advisory. It is published in the association's journal, Circulation.

Studies show that estrogen does counter some of the things that contribute to heart disease, keeping low-density "bad" cholesterol levels lower and high-density "good" cholesterol levels higher, while reducing blood pressure.

But for now, the heart association suggests that the decision on hormone treatments be based primarily on non-heart related benefits and risks.

"The new guidelines recommend essentially taking HRT out of the risk-benefit equation for women who have already had a heart attack or stroke," Mosca said.

"For postmenopausal women without heart disease, we do not suggest that HRT be taken completely out of the equation. We state that heart disease prevention should not be used as the sole purpose of therapy. It can weigh into the decision, it just shouldn't drive the decision for women without heart disease."

On the other hand, women who are already using the therapy and doing well shouldn't feel compelled to stop, the report said.

It suggested that women concerned about heart disease focus on lifestyle changes such as smoking, weight loss and physical activity known to reduce the risk of cardiovascular disease, along with drugs to lower cholesterol and blood pressure, that are often underutilized in women.

Mosca noted that the established benefits of hormone treatment for menopausal symptoms such as hot flashes, and the prevention of osteoporosis, must be weighed against increased risk for blood clots, gallbladder disease and a possible increased risk of breast cancer.

"It is important that HRT be seen as a single therapy with benefits in many areas that impact health and quality of life for post menopausal women," said Dr. Robert Langer, a professor of family and preventive medicine at the University of California-San Diego.

He noted that the results from studies based on one common regimen of hormone replacement therapy tested so far "may not generalize to other progestogens, estrogens, routes of delivery or doses."

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