Hormone Therapy Doesn't Boost Heart Attack Risk in Younger Women: Study
But it can still increase stroke and breast cancer risk, researchers add
TUESDAY, April 3, 2007 (HealthDay News) -- There appears to be no risk of heart disease for women who start hormone therapy closer to the time of menopause, compared to women who start the treatment significantly later in life, a new study found.
In fact, women taking hormone therapy within a 10-year window of the start of menopause had a slightly reduced -- although not statistically significant -- risk of developing coronary heart disease.
However, hormone therapy did increase the risk of stroke by 32 percent and that risk did not seem to vary by age or time from menopause.
Finally, even in younger women, there appeared to be an increased risk of breast cancer in women taking the hormone estrogen with a progestin.
These findings should serve to offset somewhat the worry caused by the release in 2002 of data from the landmark Women's Health Initiative, which initially reported that all long-term hormone therapy could increase the risk of coronary heart disease.
"For women who are within 10 years of the onset of menopause and (have) bad menopausal symptoms, hormone therapy is a reasonable option for four to five years," said study lead author Dr. Jacques Rossouw, chief of the Women's Health Initiative (WHI) Branch of the U.S. National Heart, Lung, and Blood Institute. "On the other hand, women who are beyond 10 years are at an increased risk from hormone therapy for coronary heart disease, particularly if they have menopausal symptoms."
Dr. Suzanne Steinbaum, director of Women & Heart Disease at Lenox Hill Hospital in New York City, added: "When the results of the Women's Health Initiative came out, there was a huge panic and women stopped taking the medication, but the results really needed to be analyzed. This (new study) allows us to tell our women patients, if you're suffering with hot flashes, if you're suffering with palpitations and not sleeping, it's OK to take hormone replacement in the short term. It still means we're not going to run out and tell a 70-year-old woman, 'I'm going to give you hormones because it will prevent heart disease,' but we never should have said that."
Rossouw stressed that, "It's OK to use hormone therapy within that window but take care of risk factors for stroke and have mammograms."
Although previous studies looking at hormone therapy in postmenopausal women had yielded conflicting results when it came to coronary heart disease, some research had hinted that age and time from menopause might influence the effect of hormone therapy.
The new study, published in the April 4 issue of the Journal of the American Medical Association, was a secondary analysis of data from the WHI trial. The original trial included 10,739 postmenopausal women, aged 50 to 79, who had undergone a hysterectomy and were randomly chosen to receive estrogen or a placebo. A second group of 16,608 postmenopausal women who had not had a hysterectomy were randomly selected to receive estrogen plus progestin or a placebo. Women who still have a uterus can't take estrogen alone because it can cause cancer.
Overall, hormone therapy did not reduce the risk of coronary heart disease. But women who began hormone therapy within 10 years of the onset of menopause (50 to 59 years of age) had a slightly lower risk of coronary heart disease than women who began the therapy later on, the study concluded.
Younger women taking hormones had a slightly reduced risk of death, but the trend was considered "nonsignificant."
Older women taking hormones who still had menopausal symptoms had a higher risk of heart disease. "This was a surprise and needs further work," Rossouw said. "For now, these women need to look carefully at their risk factors (for heart disease) rather than whether or not to use hormones."
"We think that this is helpful to women in their decision-making," he added. "Today, we don't use hormone therapy for the prevention of heart disease and these findings don't change that. But they help a little in decision-making because it defines when hormone therapy is a reasonable option and when it's not."
For more on HRT, visit the U.S. National Institutes of Health.