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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."

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