Humana HealthBeat Transcript Archive

August 25

Hormone Replacement Therapy

There’s been some controversy lately about the value of hormone replacement therapy in preventing heart disease.

Now two studies published in the New England Journal of Medicine shed some light on the subject.

In one large study of more than eighty-five thousand female nurses, 34 to 59 years old, researchers found that during the fourteen years of follow-up, heart disease declined by thirty-one percent. At that same time, smoking declined by forty-one percent and the rate of use of hormone replacement therapy increased by one hundred and seventy-five percent and diet improved as well.

According to an editorial in the New England Journal, taken together, the changes in these lifestyle factors accounted for two-thirds of the total decline. But the proportion of women who were overweight increased by thirty-eight percent, leading the authors to suggest that the incidence of heart disease might have gone down even more had weight gone down as well.

While estrogen seems to be protective for heart disease in women who don’t have a preexisting problem, it doesn’t seem to be as effective in women who already have known heart disease. In another article in the same issue, researchers found that neither estrogen alone nor estrogen plus progestin effected the amount of blockage in the coronary arteries in women with known disease.

The results from this study support a previous study that showed that estrogen therapy may not be useful, and may, in fact, be associated with an increase in cardiac events with women with known heart disease.

The study is limited by the fact that the women in the study began hormone therapy about 20 years after they reached menopause and were only followed for three years. For example, there may be some long-term benefit that this study didn’t show.

Well, does this mean that women shouldn’t take estrogen if they have heart disease?

Women with known heart disease who are taking estrogen or are thinking about starting estrogen should speak to their doctor. There may be other reasons such as treatment of osteoporosis, or symptoms that might warrant hormone therapy, but this decision needs to be made in that context.

RESOURCES:

Effects of Estrogen Replacement on the Progression of Coronary-Artery Atherosclerosis
New England Journal of Medicine
2000;343:522-9

Coronary Heart Disease in Women - An Ounce of Prevention
New England Journal of Medicine
August 24, 2000, Pages 572-574

Trends in the Incidence of Coronary Heart Disease and Changes in Diet and Lifestyle in Women
New England Journal of Medicine
2000;343:530-7

August 25
Hormone Replacement Therapy
	There’s been some controversy lately about the value of hormone replacement therapy in preventing heart disease. Now two studies published in the New England Journal of Medicine shed some light on the subject. In one large study of more than eighty-five thousand female nurses, 34 to 59 years old, researchers found that during the fourteen years of follow-up, heart disease declined by thirty-one percent. At that same time, smoking declined by forty-one percent and the rate of use of hormone replacement therapy increased by one hundred and seventy-five percent and diet improved as well. According to an editorial in the New England Journal, taken together, the changes in these lifestyle factors accounted for two-thirds of the total decline. But the proportion of women who were overweight increased by thirty-eight percent, leading the authors to suggest that the incidence of heart disease might have gone down even more had weight gone down as well. While estrogen seems to be protective for heart disease in women who don’t have a preexisting problem, it doesn’t seem to be as effective in women who already have known heart disease. In another article in the same issue, researchers found that neither estrogen alone nor estrogen plus progestin effected the amount of blockage in the coronary arteries in women with known disease. The results from this study support a previous study that showed that estrogen therapy may not be useful, and may, in fact, be associated with an increase in cardiac events with women with known heart disease. The study is limited by the fact that the women in the study began hormone therapy about 20 years after they reached menopause and were only followed for three years. For example, there may be some long-term benefit that this study didn’t show.

	Well, does this mean that women shouldn’t take estrogen if they have heart disease? Women with known heart disease who are taking estrogen or are thinking about starting estrogen should speak to their doctor. There may be other reasons such as treatment of osteoporosis, or symptoms that might warrant hormone therapy, but this decision needs to be made in that context.
	RESOURCES: Effects of Estrogen Replacement on the Progression of Coronary-Artery Atherosclerosis New England Journal of Medicine 2000;343:522-9 Coronary Heart Disease in Women - An Ounce of Prevention New England Journal of Medicine August 24, 2000, Pages 572-574 Trends in the Incidence of Coronary Heart Disease and Changes in Diet and Lifestyle in Women New England Journal of Medicine 2000;343:530-7