Another Study Sees Heart Risks in Hormone Replacement Therapy

But treatment can offer relief from menopausal symptoms for younger women, researchers say

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HealthDay Reporter

WEDNESDAY, July 11, 2007 (HealthDay News) -- Yet another study confirms that hormone replacement therapy should not be used in older women to help prevent heart disease, although it appears to be safe and effective in relieving menopausal symptoms in younger women.

In fact, in older women hormone replacement therapy (HRT) increased the risk of cardiovascular problems and blood clots, the study found.

Results of the study -- the WISDOM trial -- were published in the July 11 online issue of the British Medical Journal.

"WISDOM confirms that there's no justification for older women using hormones for prevention of heart disease," said Dr. Wulf H. Utian, executive director of the North American Menopause Society (NAMS). "But for a generally healthy perimenopausal or early postmenopausal woman suffering from genuine menopause-related symptoms that are causing her distress, then hormones are the gold standard and are basically safe."

The landmark U.S. Women's Health Initiative (WHI) trial was halted in 2002 after finding that postmenopausal women taking HRT had more heart attacks and strokes than women who did not use hormones.

More recent research has started to emerge suggesting that the risks may apply only to older women, not to those closer to menopause.

The WISDOM (Women's International Study of Long Duration Oestrogen After Menopause) trial was also halted after the first results of the Women's Health Initiative were published.

Unlike the Women's Health Initiative, however, WISDOM had not finished enrolling participants and wasn't big enough to draw firm conclusions, although the findings as they stand do confirm the WHI findings, Utian said.

The WISDOM trial looked at 5,692 healthy women, average age 63, in Australia, the United Kingdom and New Zealand.

Women who had not had a hysterectomy were randomly selected to receive combined hormone therapy (estrogen plus progesterone) or a placebo. Women who had undergone a hysterectomy were randomly chosen to receive the combined hormone treatment, estrogen alone or a placebo.

The participants were followed for an average of one year.

Those women taking the combined hormone therapy had more major cardiovascular events -- angina, heart attack or sudden coronary death -- and blood clots, compared to women taking a placebo.

The incidence of stroke, cancer, fractures and overall deaths was not markedly different between the two groups.

Overall, the findings echo other recent research and confirm a role for hormone therapy to relieve menopausal symptoms in younger women.

"The doomsday statements from the WHI investigators in 2002 that women should get off hormones, that there was too high a risk, was a lot over the top," Utian said. "WHI was never a study about menopause. It was about whether hormones could prevent heart disease in older women."

Dr. JoAnn Pinkerton, director of midlife health at the University of Virginia Health Systems and a member of the board of trustees of NAMS, said, "This [new study] confirms in a small population what we found with the WHI. HRT for [heart disease] prevention is not effective or safe. We're feeling comfortable about using HRT for menopausal symptoms potentially up to 10 years from menopause, and otherwise we have to individualize it. There are both risks and benefits."

Recent research has found that hormones may have a role in preventing heart disease in younger women, but conclusive proof is still lacking.

"NAMS is saying that even though it seems that younger women may get some preventive effect, that should be taken as a reassurance but not as a single reason in itself to prescribe hormones," Utian said.

Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in New York City, said, "HRT in younger women is safe but has risks in older women. It goes back to the age question. All of this data is so important for us to understand."

More information

Visit the U.S. National Heart, Lung, and Blood Institute for more on the Women's Health Initiative.

SOURCES: Wulf H. Utian, M.D.. Ph.D., executive director, North American Menopause Society, Cleveland; JoAnn Pinkerton M.D., director, Midlife Health, University of Virginia Health Systems, and professor, obstetrics and gynecology, University of Virginia, Charlottesville; Suzanne Steinbaum, D.O., director, Women and Heart Disease, Lenox Hill Hospital, New York City; July 11, 2007, British Medical Journal, online

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