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

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In a second study Manson and colleagues analyzed the effects of hormone replacement among nearly 2,500 nurses who had previous heart attacks or diagnosed heart disease. She says that in this study, too, in the short-term giving hormones to women who had recent heart attacks increased the risk for subsequent events. Still, long-term users of hormone replacement therapy did show some decreased risk of heart problems. Their findings are reported in July 3 Annals of Internal Medicine.

Manson says both study findings suggest that it is time for women and their doctors to rethink hormone replacement therapy. She says that short-term hormone therapy for women without heart disease "for five years or less to reduce menopause symptoms" is still a good option. But "long-term therapy, for 10 or 15 years, should be carefully weighed."

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.

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