Women who are entering menopause, and their doctors, can stop worrying that using hormone replacement therapy for relief of hot flashes and other symptoms will increase their risk of developing heart disease.
According to a new analysis from the Women's Health Initiative -- called WHI -- that focused on 50- to 59-year-old participants, neither estrogen-only nor estrogen plus progestin therapies led to a greater likelihood of coronary artery disease.
The researchers said in their report, published yesterday in the Journal of the American Medical Association, that the results suggested hormone replacement might reduce the risk for younger women and those who had been in menopause for fewer than 10 years, but statistically speaking they could not be certain.
So, "in the short term, [for] women who have menopausal symptoms, estrogen therapy or even estrogen-progestin therapy is all right," said Dr. Lewis Kuller, a WHI investigator and epidemiologist at the University of Pittsburgh Graduate School of Public Health.
"You shouldn't walk around with hot flashes every day because you're being heroic or afraid of taking hormone therapy," he said. "But you only take it for a period of time, and [it] is not prophylactic against coronary disease."
Five years ago, the National Institutes of Health, the sponsor of the initiative's project, called a halt to the estrogen-progestin portion of the study, which included more than 16,000 women 50 to 79, because of increased risks of heart attack, stroke and breast cancer.
In 2004, officials stopped the estrogen-only therapy arm because of an increased stroke risk and no reduction in heart disease risk.
Prescriptions for the hormones dropped dramatically in subsequent years.
"A lot of people got very nervous, both patients and physicians," said Dr. Suzanne M. Kavic, a reproductive endocrinologist who is clinical program director of the Jones Institute at West Penn Allegheny Health System. "[The] WHI came out and really scared a lot of people, so they took their patients off of hormone replacement completely."
The new analysis is vindication for her and other physicians, who were concerned that the original study had too many older women instead of 50-somethings who had recently entered menopause.
"Most of us are not shocked by this news," said Dr. Eugene Scioscia Jr., chairman of obstetrics and gynecology at Allegheny General Hospital.
Increased risk of strokes and breast cancer is still worrisome, and must be considered when making decisions about hormone replacement therapy, he added.
"Instead of treating all women the same as they enter menopause, we need to tailor our therapies, including hormone replacement therapy, to the particular patient," Dr. Scioscia said.
And although the treatment might provide heart benefits, "lowering cholesterol through exercise and diet is always the better way to go in managing cardiovascular disease," he noted. "That should be your first line of therapy, not hormone replacement therapy."
The need for the therapy should also be revisited regularly. Five years or fewer is probably appropriate in most cases, Dr. Kavic said.
"Of course, every woman should really go talk to her physician and be up front and candid about her symptoms and her fears," so they can be addressed, she said. "Then you can make a well-educated decision, rather than an emotional one."
By Anita Srikameswaran, Pittsburgh Post-Gazette
Thursday, April 05, 2007
4/05/2007