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HRT and Antioxidants Not Good For Heart

In fact, the treatments may be harmful

TUESDAY, Nov. 19, 2002 (HealthDayNews) -- Postmenopausal women with coronary disease do not derive any benefit from taking hormone therapy or antioxidant vitamins, either alone or in tandem.

In fact, not only were there no cardiovascular benefits, but the therapies may actually have caused harm, says a study that appears in tomorrow's Journal of the American Medical Association.

"There are a lot of women who still use these treatments with the expectation that it's going to help their heart, and we would suggest that that's not going to happen," says study author David D. Waters, chief of cardiology at San Francisco General Hospital and a professor of medicine at the University of California, San Francisco.

Adds Dr. Nieca Goldberg, chief of the Women's Heart Program at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association, "this really dispels the myth that hormone replacement therapy (HRT) is a magic pill."

Waters notes the study dealt with a narrow group of women and an equally narrow group of medications. That's not to say that hormone therapy doesn't help some women, such as those struggling with menopausal symptoms.

"The study was done in postmenopausal women with coronary disease and that doesn't mean the results are necessarily applicable to other populations," Waters says. "Not only can we not necessarily extrapolate to other populations, it's not necessarily something we can extrapolate to other medicines in the same family."

Even though HRT and antioxidant vitamins are frequently used to treat the progression of coronary disease in postmenopausal women, there is no firm data to endorse either, the article says.

Hormone therapy came under fire last summer when part of the Women's Health Initiative, a large, multi-site trial looking at disease prevention in postmenopausal women, was cancelled after some women taking HRT exhibited an elevated risk of cardiovascular disease, stroke and breast cancer.

This and other studies have painted a confusing picture as to whether or when postmenopausal women should use HRT.

This latest study, the Women's Angiographic Vitamin and Estrogen (WAVE) Trial, looked at 423 postmenopausal women who had narrowing or constriction of an artery.

Patients were randomly assigned to one of four groups: One group received HRT plus a placebo instead of antioxidant vitamins; one group got relatively high doses of the antioxidant vitamins E and C plus a placebo instead of HRT; the third group got a double placebo; and the fourth group received both HRT and antioxidant vitamins.

At the end of the three-year study, angiograms revealed that the coronary conditions had worsened in women taking vitamins, HRT or the combination.

In addition, 14 patients in the HRT groups had died versus eight who received a placebo. In the vitamin groups, 16 women had died, versus six who got a placebo.

What's more, 26 women receiving HRT died or experienced a nonfatal heart attack or stroke, versus 15 in the placebo groups. And 26 in the vitamin group had died or experienced a nonfatal heart attack or stroke, versus 18 in the placebo groups.

Neither treatment provided any benefit and both "have a trend toward a negative effect," Waters says.

"The results are disappointing and hormone replacement therapy and antioxidant vitamins don't have the benefits that we hoped they would have," Waters says.

"But the good news," he adds, "is that there are a lot of other treatments that really work to prevent heart disease in women and men, such as controlling cholesterol and diet and exercise. It's not like there's nothing else out there."

For postmenopausal women who don't have coronary disease, hormone therapy may still be an option for problems such as night sweats or vaginal dryness.

"For women who have important perimenopausal symptoms, it might still be worthwhile to take HRT for two to four years to control symptoms," Waters says. "But to take HRT with the expectation of cardiovascular benefit is not going to work either in primary or in secondary prevention."

Different forms of estrogen and progesterone also may not show the same results. "It may be that not all hormone therapies are equal," Goldberg says.

"This is a good time to sit back and take notice of the whole body of information we've had since July on HRT and heart disease," she adds.

What To Do

For more on hormone therapy, including the latest updates, visit the National Library of Medicine or the National Heart, Lung, and Blood Institute.

SOURCES: David D. Waters, M.D., chief, cardiology, San Francisco General Hospital, and professor, medicine, University of California, San Francisco; Nieca Goldberg, M.D., chief, Women's Heart Program, Lenox Hill Hospital, New York City, spokeswoman, American Heart Association and author, Women Are Not Small Men; Nov. 20, 2002, Journal of the American Medical Association
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