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Designer Estrogen Compares to Real Thing

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WebMD Health News

March 21, 2001 (Orlando, Fla.) -- Evista may be the estrogen substitute that has all the advantages of estrogen but none of the risks, says Elizabeth Barrett-Connor, MD, who presented new data here Wednesday at a meeting of the American College of Cardiologists.

 

In younger women, the female hormone estrogen protects against bone loss, or osteoporosis. But giving estrogen replacement therapy after menopause increases the risk for breast and ovarian cancer. That's where Evista enters the picture. The drug belongs to a class of estrogen knock-off drugs called selective estrogen receptor modulators, or SERMs. The drug is FDA approved for treatment or prevention of osteoporosis.

 

In addition to its bone-protective effect, many heart experts believed that estrogen protects the heart as well. The reasoning here was that women don't usually have heart attacks until they are past menopause, when they stop producing estrogen.

 

In recent years, however, two major medical studies have linked estrogen to an increased risk for early heart attack, says Barrett-Connor, a finding that left many heart experts worrying that Evista could be just as risky.

 

But now, data collected from a large study of women who took Evista to treat osteoporosis suggest that there may be some important -- and comforting -- differences between Evista and estrogen.

 

"[T]here is no evidence of early harm [to the heart] with raloxifene," says Barrett-Connor, a professor of medicine at the University of California, San Diego. In fact, she says that Evista may lower cholesterol, the same positive effect that is also seen with estrogen use. "It lowers total cholesterol and LDL but does not appear to have an effect on HDL," she says. LDL is the so-called "bad" cholesterol that is linked to heart disease, and HDL, or good cholesterol, protects the heart.

 

Although estrogen does appear to offer a long-term benefit in protecting the heart from disease, Evista doesn't. She says, however, that the new findings are not the final word on Evista. The data come from an osteoporosis study, "not a heart study, and so the study wasn't really designed to look for heart disease," she says. Also, most of the women studied were actually pretty healthy: 7,000 women were enrolled in the study, but only 202 had heart disease.

 

Sidney Smith, MD, chief science officer for the American Heart Association, agrees. "I think we need a larger study that is designed to look at these specific questions," he tells WebMD. "Nonetheless, these results are certainly reassuring."

 

Barrett-Connor tells WebMD that a larger trial is already looking at the potential heart benefits of Evista. But results from that study "won't be available for several years," she says.

 

And she points out that the women in the osteoporosis study were only followed for three years. "That may not be long enough to see a long-term benefit," says Barrett-Connor.

 

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