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Possible heart benefit in hormome therapy-study

Posted on: Monday, 13 February 2006, 16:02 CST

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.

Source: REUTERS

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