Heart
Risk for Younger Women May Be Lowered with Estrogen
Women in their 50s who take estrogen therapy have lower
levels of dangerous calcium deposits in their arteries, suggesting they are
at reduced heart disease risk, says a new report.
The study authors, reporting in the New
England Journal of Medicine, say the results should reassure younger
women who use supplemental estrogen to lessen their menopausal symptoms.
They
also caution that it should not be seen as a license to use hormone-replacement
therapy (HRT) to prevent heart
disease.
The findings
should "provide reassurance to younger women
who are wrestling with the decision, that hormones are unlikely to have an
adverse effect on the heart and may even slow the early stages of plaque build-up," says
lead researcher Dr. JoAnn Manson, at Brigham and Women's Hospital in Boston.
However, "the study should not be interpreted to mean that
women should take estrogen to prevent cardiovascular disease. There are other
risks to hormones, including the risk of blood clots in the legs," notes Dr.
Manson.
Dr. Suzanne Steinbaum, at Lenox Hill Hospital in New York
City, says the study becomes very important but not for prevention and not
for treatment of heart disease, but to alleviate the fears of people in the
context of developing heart disease if they are taking HRT.
"Women aged 50 to 59 who are having [menopausal] symptoms
can really say, 'I can take HRT without getting heart disease,' " says Dr.
Steinbaum.
Statements from numerous organizations echoed those sentiments.
"The results... are very encouraging," states
the International
Menopause Society.
The group
also notes that the CT scans used in the trial were performed at a mean age
of just under 65 years of age.
That "suggests
a new 'safety margin' for age and duration of estrogen therapy, as women can
be reassured that estrogen therapy is cardioprotective at least until age 65,” states
the Society.
The findings "provide additional reassurance to women in
their fifties that there is little risk in beginning estrogen therapy to treat
menopausal symptoms such as hot flashes, night sweats, and discomfort with
intercourse," says Dr. Robert W. Rebar, executive director of the American
Society for Reproductive Medicine. "In fact, estrogen may actually protect
against development of heart disease."
The new
study is based on data from the landmark Women's
Health Initiative (WHI) trial. It is the first randomized trial
to examine the relationship between estrogen therapy and coronary artery
calcium in this age group.
The original WHI was
halted when researchers found an increased risk of adverse events which, depending
on whether the woman was taking estrogen alone or estrogen plus progestin,
included heart attack, stroke, breast cancer, and blood clots. Dr. Manson was
one of the principal investigators on the WHI trial.
"That study enrolled women aged about 50 to 79,” says
Farida Sohrabji, Ph.D., at Texas A&M Health Science Center in College Station,
Tex.
“Many had been postmenopausal for decades and some
had never had symptoms such as hot flashes and sleepless nights,” she
notes. “Collectively, it was bad news."
When
older and younger women in the study were looked at together, "women who took hormones had a higher incidence of cardiovascular
disease," says Dr. Sohrabji. "But if you looked very carefully even at that
old data, in the youngest group - 50 to 59 - there was a hint that it wasn't
really bad for the heart."
The new trial focused on younger women - specifically, 1,064
women aged 50 to 59 who had undergone a hysterectomy and who were randomly
selected to receive either estrogen or a placebo.
The treatment lasted a mean of 7.4 years and there was an
additional follow-up of 1.3 years.
Women receiving estrogen were 30 percent to 40 percent less
likely to have severe coronary artery calcium than women on the placebo, notes
Dr. Manson's team.
Women who had at least 80 percent adherence to the medication
had a 60 percent lower risk of severe coronary calcium, as well.
"The data are very convincing,” says Dr. Sohrabji. ”They
show that the women who took estrogen replacement therapy clearly have much
smaller plaque than women who took a placebo. But early postmenopausal and
late postmenopausal women need to be treated as different groups. That's really
critical."
And the use of hormones does need to be restricted to the
relief of menopausal symptoms, not as a means of preventing heart disease,
she adds.
"It is showing that women who do take [estrogen] have a
decreased incidence of heart disease," says Dr. Steinbaum. "Maybe at some point
down the line we might say it's OK for [heart disease] prevention but right
now they can't say that. Don't take [hormones] for prevention."
Always consult your physician for more information.
(Our
Organization is not responsible for the content of Internet sites.)
American
Heart Association
American
Society for Reproductive Medicine
International
Menopause Society
National
Heart, Lung, and Blood Institute (NHLBI)
National
Women's Health Information Center
National
Women's Health Information Center - Heart Disease
New
England Journal of Medicine
New
England Journal of Medicine - Estrogen Therapy and Coronary-Artery Calcification
NIH
- Heart Disease in Women
North
American Menopause Society
Women's
Health Initiative (WHI) |
