HRT: Where Are We Now?
Is hormone therapy (HRT) making a comeback?
Hormone Replacement Therapy: The New Evidence continued...
In one recent study, Salpeter and her colleagues found that HRT reduced the
number of heart attacks and cardiac deaths by 32% in women who were 60 or
younger (or women who had been through menopause less than 10 years ago). In
older women, hormone replacement therapy seemed to increase cardiac events in
the first year, and then began to reduce them after two years.
The 32% drop is significant, but perhaps not as dramatic as it sounds. In
hard numbers, Salpeter estimates that of women aged 50 to 59 who don't get
hormone replacement therapy, about 7 out of 4,800 will have a cardiac event in
one year. With HRT, 3 out of 4,800 will have a cardiac event.
Hormone Replacement Therapy: Why Age May Matter
Salpeter's study indicates something crucial: The age at which a woman
starts HRT may make a big difference.
Salpeter argues that when a person first starts hormone replacement therapy,
her risk of blood clots increases slightly. In healthy women who are in their
50s -- and close to the age of menopause -- this increase is very unlikely to
cause problems. The higher risk subsides after a couple of years, she says,
although other experts disagree.
But women in their 60s may be more likely to already have early heart
disease or hardening of the arteries (arteriosclerosis). In these cases, the
risk of blood clots becomes more serious. So if a woman first starts hormone
replacement therapy in her 60s, the initial risks are more dangerous, Salpeter
This is what Salpeter says affected the results of the Women's Health
Initiative trial. The average age of a woman in that trial was 63, with a range
of ages between 50 and 79. She
and other critics argue that the researchers were looking at many women
who might already have been sick.
"I was surprised when I first heard the [WHI] results," says Lynne T.
Shuster, MD, director of the Women's Health Clinic at the Mayo Clinic in
Rochester, Minn. "But, once I saw the details, I wasn't surprised anymore. They
gave women who were older and possibly had underlying arteriosclerosis a pill
that increased the risk of blood clotting. Of course it increased the risk of
Shuster and Salpeter argue that those results have no bearing on whether
younger, healthy women in their 50s would benefit from HRT.
"Basically, [the WHI researchers] were looking at the wrong group of
people," Salpeter tells WebMD.
Rossouw defends the WHI study design. "We were specifically testing the
hypothesis that hormone therapy would help protect older women against
disease," Rossouw tells WebMD, "The results were absolutely clear: They do