Hormone Therapy: Heartening News
Estrogen Doesn't Harm, Seems to Protect Hearts of 50+ Women
Hormone Therapy: Timing Key to Benefit
The WHI trial was designed to see whether long-term treatment with combined estrogen plus progestin (Prempro) (or, for women who have had hysterectomies, estrogen alone (Premarin)) offered health benefits after menopause. The study enrolled women up to age 79.
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.