American Heart Association Discourages HRT to Prevent Heart Disease
July 23, 2001 -- In a dramatic change in the field of heart disease prevention, the American Heart Association is advising doctors to stop prescribing hormone replacement therapy to women to prevent heart disease. Moreover, the AHA says that healthy women should not be told that taking estrogen might protect their hearts.
The AHA also is advising that estrogen be stopped immediately if a woman has a heart attack and that hormone replacement only be resumed after careful consultation between a woman and her doctor.
But "healthy women who are taking estrogen don't need to be afraid," because the new advisory concerns only women who have heart disease, says heart specialist Lori Mosca, MD, PhD, author of the AHA's science advisory published in Circulation: Journal of the American Heart Association.
Women who have a history of heart disease and who are taking hormone replacement therapy, either estrogen alone or estrogen/progestin combination therapy, should talk to their doctors about the risks and benefits of continued therapy.
Mosca, director of preventive cardiology at New York Presbyterian Hospital of Columbia University and Cornell University, tells WebMD that the AHA acted quickly in response to new information. The new information is a spate of recent studies suggesting that estrogen replacement may actually increase the risk for heart attack in some cases.
The concern about estrogen in women with heart disease comes on top of studies that link hormone replacement to increased risk for breast cancer.
The final word on the risks and benefits of hormone replacement for healthy women will come from an ongoing federal study called the Women's Health Initiative, which will not be completed until 2005.
Wulf Utian, MD, executive director of the North American Menopause Society, tells WebMD that the AHA advisory is very similar to an advisory issued late last year by the International Menopause Society. "It is basically don't start, don't stop," says Utian. For women who have heart disease, hormone replacement should not be initiated, but if a woman is already taking estrogen, there is no reason to stop.
Mosca says she has no qualms about prescribing hormone replacement for a healthy woman who is experiencing menopause symptoms such as hot flashes and sleep disturbances because estrogen remains the best treatment for these symptoms. Hormone replacement can also protect against bone-thinning osteoporosis, but Mosca points out that there are other compounds -- such as Fosamax, Evista, or Calcitonin -- that are used to both prevent and treat osteoporosis.
Mosca says that when doctors are counseling healthy women about hormone replacement, that counseling should omit any suggestion that hormone replacement can prevent heart disease. Women who are interested in heart disease prevention should direct their efforts toward lifestyle modification, says Mosca: for example, smoking cessation, weight loss, and regular exercise. Appropriate medications should be considered for women who have high blood pressure or high cholesterol.