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Hormone Therapy May Not Protect Heart

Hormone Therapy May Not Protect Heart
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WebMD Health News

July 2, 2002 -- Hormone replacement therapy does not reduce the risk of heart attack and death from coronary events in older women with existing heart disease, findings from a widely anticipated study suggest.

Experts say data from the Heart and Estrogen/Progestin Replacement Study Follow-Up (HERS II) trial offer definitive evidence that hormone therapy is not protective against heart disease progression in postmenopausal women with pre-existing heart disease. And it casts further doubt on its heart-protective value in women without heart disease.

"It is fair to say that there is a growing dark cloud surrounding this treatment," says Diana B. Petitti, MD. "There is growing uncertainty regarding the risks and benefits of hormone replacement therapy. I think more and more women who are on it for prevention will begin to [say no to HRT]."

Millions of menopausal and postmenopausal women take hormone replacement therapy (HRT). It remains the most effective treatment for the symptoms of menopause, but it has also been widely prescribed for protection against heart disease and bone-thinning osteoporosis. There is also some evidence of a protective benefit against Alzheimer's disease. On the negative side, HRT has been linked to an increased risk of breast cancer, ovarian cancer, blood clots, and gallbladder disease.

The original HERS trial involved almost 2,800 postmenopausal women with heart disease who were followed for four years. Women on HRT were found to have an increased risk of coronary events during the first year of treatment and a decreased risk in subsequent years, compared with women on placebo treatment.

At the time, researchers speculated that longer follow-up would make the heart-protective benefits of hormone therapy more obvious, but the newly released report does just the opposite. The new findings, published in the July 3 issue of TheJournal of the American Medical Association, showed that women on HRT for almost seven years were just as likely to have heart attacks and die of heart disease as women who were not on the therapy.

"Despite the fact that almost half of the women originally assigned to hormone therapy were still taking hormones at the end of follow-up, there was no evidence of overall benefit for any cardiovascular outcome," lead researcher Deborah Grady, MD, and colleagues wrote.

There was also no evidence that hormone therapy protected against bone fractures associated with osteoporosis, but women on HRT were found to be at increased risk for blood clots and gallbladder disease.

Petitti, who wrote an editorial assessing the new findings, tells WebMD that though there is mounting evidence showing hormone replacement does not protect the heart, the jury is still out on its ability to protect against bone loss and related fractures. In addition, she says, research on the protective role of hormones against age-related dementia has only just begun.

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