Hormone Therapy: Heartening News
Estrogen Doesn't Harm, Seems to Protect Hearts of 50+ Women
Hormone Therapy: Timing Key to Benefit continued...
The estrogen-plus-progesterone arm of the study was halted early, after five
years, when it became clear that, overall, women taking Prempro had an
increased risk of breast cancer, dangerous blood clots, stroke, and heart
disease. However, there was no increased risk of death -- and a significant
benefit in reducing hip fracture due to bone loss.
The estrogen-only arm of the trial continued. These results, plus new
analyses of the earlier data, strongly suggested that hormone therapy was far
less risky and far more beneficial when begun soon after menopause.
That's why Manson and colleagues took a closer look at 50- to 59-year-old
women in the estrogen-only arm of the study. They used CT scans to measure
calcium deposits in the women's coronary arteries -- an excellent predictor of
hardening of the arteries and future heart disease.
They found that about 7.5 years after starting hormone therapy -- and more
than a year after the trial ended -- women taking estrogen were 30% less likely
to have serious hardening of the coronary arteries.
Women who took their estrogen pills every day did even better. They had more
than a 60% lower risk of serious hardening of the arteries.
"This suggests that estrogen was slowing the different stages of plaque
buildup in the arteries," Manson says. "These findings, together with
earlier findings that women taking estrogen have lower rates of heart attack
and coronary artery bypass and balloon angioplasty, provide reassurance that
for recently menopausal women, estrogen will not have an adverse effect on
their heart and may even have some benefit."
Howard Hodis, MD, director of atherosclerosis research at the University of
Southern California, is far more convinced of the heart benefits of hormone
therapy. Hodis, who spoke at the Wyeth news conference, is a paid consultant to
Wyeth (and other pharmaceutical companies) but says his opinions are not those
of the company.
"The timing issue is absolutely crucial -- below the age of 60, probably
right at the time of menopause, is when women want to start hormone
therapy," Hodis says. "Early initiation of hormone therapy ... is quite
efficient at reducing coronary artery disease. Taken together with previous
reports ... we see that with estrogen-only hormone therapy, we have not only
seen a reduction in coronary heart disease and overall mortality but also
no risk of breast cancer, stroke, and other adverse outcomes."
"My patients are more worried about hormone therapy causing breast
cancer than about heart disease," Warren says. "But there is no
increased risk of breast cancer with estrogen alone, only with estrogen plus
progesterone, and the risk is tiny."
Statements from leading menopause societies largely support the opinions
expressed by Warren and Hodis.
"We are clearly learning that the benefits of estrogen in young,
healthy, postmenopausal women outweigh the risks," says Robert W. Rebar,
MD, executive director of the American Society for Reproductive Medicine.
"Since most, if not all, women do not start hormone therapy at an old
age, safety concerns on its possible adverse cardiac effects are actually
invalid for the vast majority of hormone users," reads a statement from the
International Menopause Society. "In fact, treatment seems to be associated
with reduction of risk for coronary artery disease if initiated early."