American Heart Association Discourages HRT to Prevent Heart Disease
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.
For years, one of the cornerstones of preventive medicine was the belief that estrogen protects the heart. In the years before menopause, when women produce estrogen naturally, women are almost immune to heart disease, but after menopause the heart disease risk for women climbs until it equals that for men. Based on this observation as well as animal studies that demonstrated that estrogen had a beneficial effect on blood vessels, medical experts believed that replacing estrogen after menopause could reduce the risk of heart disease in older women.
Throughout the 1980s and most of the 1990s this belief was bolstered by the results from large studies, which showed that women who take hormone replacement therapy had fewer heart attacks and strokes than women who didn't take hormones. The belief was so strong that in the AHA's 1995 guidelines on preventing second heart attacks in people with heart disease doctors were told to "consider estrogen for all women with heart disease," says Mosca.
Nonbelievers raised questions about the weakness of these studies citing, for example, data that suggested women who take hormone replacement are less likely to smoke, more likely to be well educated, and more likely to exercise and eat healthy diets. In short, these women have a low risk for heart disease because of their lifestyle.