Possible heart benefit in hormome therapy-study

By Michael Conlon

CHICAGO (Reuters) – Hormone replacement therapy using
estrogen only does not provide overall protection against heart
attacks but there may be some benefit against heart disease in
younger menopausal women, a study said on Monday.

The study from George Washington University in Washington,
D.C., is the second to suggest that hormone replacement
therapy, or HRT, is safer in younger women just entering
menopause than it is in older women well past it.

The findings were based on an analysis of part of a highly
publicized 2002 study called the Women’s Health Initiative, or
WHI, which found the therapy in general raised the risk of
heart attack, stroke, breast cancer and other serious
conditions.

After it came out, millions of women stopped HRT and sought
alternatives. Prior to that, it had been promoted as a way of
preventing heart disease.

The original WHI study was funded by the National Heart
Lung and Blood Institute with Wyeth providing the drugs.

Monday’s report, published in the Archives of Internal
Medicine, looked at the arm of the study that involved estrogen
only, as opposed to estrogen in combination with progestin.

It concluded estrogen “provided no overall protection
against (heart attack) or coronary death in generally healthy
post-menopausal women during a seven-year period of use.”

However “there was a suggestion of lower coronary heart
disease risk with (the drug) among women age 50 to 59″ when the
WHI study started, it said.

After the 2002 WHI study came out experts cautioned women
to only take hormone replacement drugs in the lowest possible
doses and for the shortest possible time. Sales of Wyeth’s
Premarin (estrogen only) and the company’s other female hormone
replacement drug, Prempro, (estrogen-progestin) fell
dramatically.

But experts said the average age of the women in the WHI
study was well above 60, and well past menopause. Such women
already may have been suffering the health effects of aging
when they started HRT.

NO INCREASED RISK OF HEART DISEASE

A study published last month in the Journal of Women’s
Health also found that women who started taking replacement
drugs as they began menopause — which typically starts in the
mid-40s and lasts through the mid-50s — had a 30 percent lower
risk of heart disease than women who did not take them.

“Both studies clearly show no increased risk of coronary
heart disease with estrogen-alone therapy,” said Ginger
Constantine, Wyeth’s vice president for women’s health care.

“Wyeth continues to support the appropriate use of hormone
therapy for its approved indications — the relief of moderate
to severe menopausal symptoms such as hot flashes, night sweats
and vaginal dryness and the prevention of post-menopausal
osteoporosis,” she said.

She said estrogen or estrogen-progestin “should not be used
for the prevention or coronary heart disease” and Wyeth
“recommends that therapy be taken at the lowest effective dose
for the shortest duration.”

Joseph Sanfilippo, president of the American Society for
Reproductive Medicine, commenting on Monday’s study, said,
“Many women may find the results of the WHI trials confusing
and contradictory, and to some extent they are.

“The earlier studies indicated that for older women (the
therapy) did not protect them against heart disease. These data
though, point out that for women in their 50s estrogen may in
fact benefit their cardiovascular health,” he said.

“The fact is there is no right answer for every woman. This
study simply confirms what most of us have been saying all
along, namely that decisions about whether a woman should be on
hormone therapy must be made for each woman individually in
conjunction with her physician,” he said.