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Short-Term Hormone Replacement Tied to Increased Risk for Recurrent Heart Attack

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She says that other studies have linked long-term hormone replacement use with increased risk for breast cancer and "without an indication for heart disease prevention" it is difficult to make a case for long-term treatment. Estrogen is also touted for its ability to protect bones but Manson says other drugs can provide this protection without increasing the risk for heart attack or breast cancer.

University of California, San Francisco researcher Deborah Grady, MD, MPH, tells WebMD that hormone replacement has been reduced to "two very important issues: one is this early increased risk that seems to occur and second, perhaps more important, is the question of whether there is any effectiveness long term." Grady, who heads women's health research at UCSF, co-authored an editorial that accompanies Newby's study.

She says, "there are no randomized trials that show long-term benefit."

Grady says she thinks the latest studies should "really change thinking about [hormone replacement therapy] ... in my own mind I see no justification for long-term treatment."

These two studies, along with the earlier study that raised red flags about risks of hormone replacement, are all secondary prevention studies, says Newby. Secondary prevention refers to treatments used to stop spread of an already existing disease.

Proponents of hormone replacement say the real issue is primary prevention: preventing the onset of disease in healthy people. Hormone replacement, the argument goes, will prevent heart disease if it is started before heart disease begins.

Newby doesn't buy this argument. "I know of no study in which a treatment that failed in secondary prevention was effective in primary prevention," she says.

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