Estrogen Therapy May Offer Some Protection, Study Finds

A new analysis of postmenopausal women on estrogen therapy still finds little or no heart health benefit from hormones among women in their 60s and 70s, but suggests that healthy women who start the treatments in their 50s may get some protection from coronary disease.

The study, published Monday in the Archives of Internal Medicine, was part of the Women’s Health Initiative, a major test of the risks and benefits of hormone replacement after menopause that was abruptly stopped in July 2002 when it became apparent that the dangers from hormones, including a higher risk of heart disease, outweighed any benefits.

But while hormone therapy is no longer advised as preventive medicine for older women, the Food and Drug Administration and the American College of Obstetricians and Gynecologists still sanctions using the smallest dose possible for the shortest length of time possible by women who are experiencing moderate to severe menopausal symptoms.

“We’re not suggesting that the pendulum should swing back on hormone replacement therapy, but the findings from our analysis should be reassuring to younger women who are considering treatments for menopausal symptoms and do indicate that more research is needed in this area,” said Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women’s Hospital in Boston and a co-author of the study.

She stressed that the estrogen evidence so far isn’t strong enough at this point to justify using the treatments to ward off heart disease among women of any age.

The new analysis was from the part of the WHI that tested estrogen therapy alone, randomly assigning 10,739 women ages 50 to 79 who had undergone a hysterectomy to either take a mixture of several estrogens or a placebo.

Overall, the risk of coronary deaths, heart attacks, bypass surgery or angioplasty was similar for the women taking hormones and the women who did not.

But among the 1,396 women in the study who were 50 to 59 when it began, the risk of those events was 34 percent less in those taking estrogen than those in the placebo group, although incidence of the events was low in both groups.

The younger women taking estrogen also scored better on such heart-disease risk factors as cholesterol levels, blood-fat levels, inflammatory factors and clotting factors, Manson said.

Dr. S. Mitchell Harman, director and president of the Kronos Longevity Research Institute in Phoenix, said both another recent population study of nurses taking estrogen and animal studies indicate that early treatment with estrogen may mitigate the particularly heavy toll on arteries that many women experience in the first decade after menopause.

American women reach menopause at an average age of about 51, and within 10 years, 35 percent to 40 percent have thickening and calcification in the arteries sufficiently that they could suffer a heart attack at any time, he said.

So the Kronos Institute is setting up another study of 720 younger women to consider the risks and benefits of early menopausal hormone therapy to see if the timing of such treatments makes much difference.

“There’s mounting evidence that hormone therapy may produce different heart outcomes for younger and older women,” Manson said. “The notion that hormone therapy is good or bad for all women is an oversimplification, and we need more research to improve our understanding.”

(Contact Lee Bowman at BowmanL(at)SHNS.com. Distributed by Scripps Howard News Service, http://www.shns.com)

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