Hormone Replacement Therapy


Home About Us Links Archive Feedback Disclaimer	Novermber 1, 2000 Hormone Replacement Therapy - Still Controversial Jane Magro, F.N.P., Riverside Cardiology Associates Medical Group Coronary heart disease (CHD) remains the leading cause of death among women as it is in men. Despite this, most women fear breast cancer the most. A postmenopausal woman is 10 times more likely to die of heart disease than she is to die of breast cancer. Among risk factors for heart disease for women, the issue of postmenopausal hormone status has received much attention. Observational studies have found lower rates of CHD in postmenopausal women who use estrogen. Estrogen's protective benefit was observed to be especially strong in women who already had established CHD. Based on this observational data, the use of postmenopausal estrogen has been proposed as the standard of care for women in the United States. Important to mention however, is that the cardioprotective benefits of this strategy have not been confirmed in clinical trials. Several mechanisms for estrogen's cardioprotective effect have been proposed. They include: Favorable changes in plasma lipid levels (lower LDL, higher HDL) Antioxidant effects Favorable hemostatic effects Favorable vasomotor effects A recent study however, the HERS trial (The Heart and Estrogen/Progestin Replacement Study) has found that estrogen has no cardioprotective effect in women with established heart disease. The HERS study is the only randomized, double-blind, placebo-controlled trial of one hormone replacement therapy (HRT) regimen completed thus far. This study also demonstrated increased coronary heart disease risk in the first year of treatment. A trend toward benefit for treated women occurred in the fourth and fifth years of the study. What is unclear is whether the benefits seen with estrogen are related to other, unmeasured factors or whether they reflect their use in healthy women with no heart disease. Observational studies may be misleading because most of the women in these studies were relatively young and healthy. Also, women who take postmenopausal hormones tend to have a better CHD risk profile and to obtain more preventive care than nonusers. Other non-cardiac benefits of estrogen and hormone replacement therapy have been identified. Estrogen's ability to prevent osteoporosis is well documented. Also, hormone therapy is effective in managing the symptoms of menopause such as hot flashes and urogenital tract atrophy. Estrogen may also have a potential role in reducing the risk of colon cancer. Other findings of interest are that estrogen replacement therapy may help protect women from Alzheimer's Disease. These above findings were noted by observational data. Randomized trial data are needed to confirm these associations. The decision about whether to use HRT in postmenopausal women and for how long to use it must be made based on each woman's relative risks of CHD, osteoporosis, venous thromboembolism (VTE), and breast or endometrial cancer and on her concerns. Based on the HERS data, HRT should probably not be initiated in women who already have CHD unless other factors that strongly support its administration are present. In women with established CHD who are already receiving HRT, it is not necessary to withdraw treatment. Continuous monitoring for breast cancer and VTE is indicated however. Additional long-term clinical trials regarding HRT are currently on-going. Results of these trials will hopefully add further information and recommendations regarding this important women's issue. Top of Page

Material copyright © 1999-2005 Riverside Cardiology Associates Medical Group Reproduction in whole or in part in any form or medium without express written permission of Riverside Cardiology Associates Medical Group is prohibited.

Home
About Us
Links
Archive

Feedback
Disclaimer

Novermber 1, 2000

Hormone Replacement Therapy - Still Controversial

Jane Magro, F.N.P., Riverside Cardiology Associates Medical Group

Jane Magro, F.N.P. Coronary heart disease (CHD) remains the leading cause of death among women as it is in men. Despite this, most women fear breast cancer the most. A postmenopausal woman is 10 times more likely to die of heart disease than she is to die of breast cancer.

Among risk factors for heart disease for women, the issue of postmenopausal hormone status has received much attention. Observational studies have found lower rates of CHD in postmenopausal women who use estrogen. Estrogen's protective benefit was observed to be especially strong in women who already had established CHD. Based on this observational data, the use of postmenopausal estrogen has been proposed as the standard of care for women in the United States. Important to mention however, is that the cardioprotective benefits of this strategy have not been confirmed in clinical trials. Several mechanisms for estrogen's cardioprotective effect have been proposed. They include:

Favorable changes in plasma lipid levels (lower LDL, higher HDL)
Antioxidant effects
Favorable hemostatic effects
Favorable vasomotor effects

A recent study however, the HERS trial (The Heart and Estrogen/Progestin Replacement Study) has found that estrogen has no cardioprotective effect in women with established heart disease. The HERS study is the only randomized, double-blind, placebo-controlled trial of one hormone replacement therapy (HRT) regimen completed thus far. This study also demonstrated increased coronary heart disease risk in the first year of treatment. A trend toward benefit for treated women occurred in the fourth and fifth years of the study.

What is unclear is whether the benefits seen with estrogen are related to other, unmeasured factors or whether they reflect their use in healthy women with no heart disease. Observational studies may be misleading because most of the women in these studies were relatively young and healthy. Also, women who take postmenopausal hormones tend to have a better CHD risk profile and to obtain more preventive care than nonusers.

Other non-cardiac benefits of estrogen and hormone replacement therapy have been identified. Estrogen's ability to prevent osteoporosis is well documented. Also, hormone therapy is effective in managing the symptoms of menopause such as hot flashes and urogenital tract atrophy. Estrogen may also have a potential role in reducing the risk of colon cancer. Other findings of interest are that estrogen replacement therapy may help protect women from Alzheimer's Disease. These above findings were noted by observational data. Randomized trial data are needed to confirm these associations.

The decision about whether to use HRT in postmenopausal women and for how long to use it must be made based on each woman's relative risks of CHD, osteoporosis, venous thromboembolism (VTE), and breast or endometrial cancer and on her concerns. Based on the HERS data, HRT should probably not be initiated in women who already have CHD unless other factors that strongly support its administration are present. In women with established CHD who are already receiving HRT, it is not necessary to withdraw treatment. Continuous monitoring for breast cancer and VTE is indicated however. Additional long-term clinical trials regarding HRT are currently on-going.

Results of these trials will hopefully add further information and recommendations regarding this important women's issue.

Top of Page

Material copyright © 1999-2005 Riverside Cardiology Associates Medical Group
Reproduction in whole or in part in any form or medium without express written permission of Riverside Cardiology Associates Medical Group is prohibited.