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Hope That Hormone Therapy Helps Heart

Hormone Therapy Increases Heart-Failure Survival
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Sept. 30, 2003 -- A new study suggests women with heart failure live longer if they are on hormone therapy.

The finding does not come from a clinical trial of hormone therapy. Instead, JoAnn Lindenfeld, MD, and colleagues looked back at hormone-therapy data collected in a clinical trial of patients with severe heart failure and the effects on survival in those taking a blood pressure-lowering drug. The trial included 490 women aged 50 and older.

Their finding: Women with heart failure who take hormone therapy are 40% less likely to die over a three-year period. Adjusting for other heart risk factors, taking hormone therapy increased a woman's chances of three-year, heart-failure survival from 58% to 78%.

This benefit was seen only in women whose heart failure was not caused by blocked arteries. In the study, hormone therapy included any form of estrogen replacement, progestin therapy, or a combination of both. There was no difference in survival between the groups that took combination HRT and unopposed estrogen.

"Hormone replacement therapy is associated with a marked improvement in survival in postmenopausal women with advanced heart failure," Lindenfeld and colleagues conclude in the Oct. 1 issue of the Journal of the American College of Cardiology. Lindenfeld is a researcher at the University of Colorado Health Sciences Center and the Center for Women's Health Research in Denver.

The findings are remarkably similar to an earlier study. Different researchers using a similar look-back method found that hormone therapy increased heart-failure survival by 38%.

Heart Benefit of Hormone Therapy Still Uncertain

These findings have to be taken with a grain of salt -- perhaps several grains, suggests Diana B. Petitti, MD, MPH, in an editorial. She notes that clinical trials of hormone therapy -- the HERS, ERA, and, most recently, the WHI trials -- Fail to show a heart benefit. In fact, the WHI actually found that HRT boosted the risk of heart disease.

Petitti, of Kaiser Permanente Southern California, Pasadena, says that there's more to know about hormone therapy and its effects on heart health. But she warns against reading too much into the Lindenfeld study.

"The [Lindenfeld] data are a minor reprieve for hormones and the heart," she writes. "Knowledge of the past suggests extreme caution, and clinical practice should not be changed based on these findings."

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