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    American Heart Association Discourages HRT to Prevent Heart Disease


    When hormone replacement was studied in a more controlled setting among women who had heart attacks the findings were surprising -- not only did estrogen not prevent a second heart attack but also it appeared to increase the risk of having one. Another study among women who have heart disease tracked the effect of estrogen on the heart arteries and found that estrogen did not slow hardening of the arteries -- which can lead to heart disease.

    Late last month these findings were replicated in two more studies.

    Utian says the belief that hormone replacement protected the heart was a big factor in convincing American doctors to recommend the treatment and American women to take estrogen, but he says he isn't sure what impact the AHA advisory will have on the use of estrogen. "I don't think most women come into a doctor's office saying 'I want hormones to protect my heart,'" says Utian.

    "Women stay on hormones because of quality-of-life issues: They feel better, sex improves," says Utian. Mosca agrees that "hormones make women feel better" and that is a powerful impetus to keep taking the pills.

    For that reason some women will want to resume taking hormones after a heart attack, she says. Although the AHA is recommending that hormones be stopped right after a woman has a heart attack, Mosca says it is not making a firm recommendation on resuming hormone therapy. That decision, she says, should be based on extensive consultation between the woman and her doctor.

    The following are some topics a woman should discuss with her doctor before starting or resuming hormone replacement therapy:

    • Family history of heart disease
    • Other risk factors for heart disease
    • Duration of HRT use
    • Dosage of HRT
    • Perimenopause
    • Alternatives to HRT, for instance, other drugs to reduce the risk of osteoporosis and heart disease
    • Lifestyle changes

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