Estrogen HRT Might Lower Risk Of Heart Disease For Women In Their 50s, Study Says

Main Category: Heart Disease
Also Included In: Menopause;  Endocrinology
Article Date: 18 Feb 2006 - 0:00 PDT

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Women who take estrogen as a hormone replacement therapy from ages 50 to 59 might have a lower risk of developing heart disease, according to a study that is part of the NIH-funded Women's Health Initiative published in the Feb. 13 issue of the Archives of Internal Medicine, the Washington Post reports (Stein, Washington Post, 2/14). In July 2002, NIH researchers ended a WHI study on combination HRT three years early because they determined that the treatment might increase the risk for heart disease, invasive breast cancer and other health problems (Kaiser Daily Women's Health Policy Report, 2/3). In that study, women took a combination of estrogen and progestin (Peres, Chicago Tribune, 2/14). For the most recent results, researchers examined 10,739 women enrolled in the WHI, ages 50 to 79, who had hysterectomies (Washington Post, 2/14). Half of the women were randomly assigned to receive Wyeth's estrogen pill Premarin and half were assigned to receive a placebo (Grady, New York Times, 2/14). Women with intact uteruses are not given estrogen alone because it increases the risk of developing uterine cancer, according to the Post (Washington Post, 2/14). Researchers in 2004 released preliminary results showing that women who received the estrogen had neither an increased nor decreased risk of heart disease compared with women taking the placebo. Researchers then followed up the results of the 3,310 women who were ages 50 to 59 when the study began to examine the prevalence of heart disease among the group about seven years after receiving the placebo or Premarin. Researchers found that 46 women who took Premarin died of a heart attack, had a heart attack or had symptoms of heart or cardiovascular disease, and 70 women who took the placebo experienced such symptoms -- a 34% lower risk for the Premarin group (Washington Post, 2/14). In addition, the study found that the Premarin group had a 45% lower risk of needing a bypass surgery or angioplasty compared with the placebo group.

Implications, Reaction
The study is "the latest piece in an increasingly complicated hormone puzzle," the Wall Street Journal reports (Parker-Pope, Wall Street Journal, 2/14). According to the Times, the study "lend[s] support" to some researchers' theory that HRT might help prevent heart disease for women early in menopause but might have no benefit or cause increased health risks if women begin the therapy at later ages (New York Times, 2/14). "We still believe that [HRT] should not be used for the express purpose of preventing cardiovascular disease," JoAnn Manson, a professor at Harvard School of Public Health and co-author of the study, said. However, she added that "this study does suggest that there may be a window of opportunity for younger women to receive heart benefit from hormone therapy" (Chicago Tribune, 2/14). Some critics of the study said the number of women involved and the way the data were analyzed make the results "highly questionable," according to the Post. Marcia Stefanick, a professor at Stanford University School of Medicine, said the study sends a "deceptive message" because estrogen might raise the risk of other health problems including stroke and blood clots. "It confuses the public, and at this point it is just not helpful to add to the confusion," Stefanick said (Washington Post, 2/14). A Wyeth spokesperson said the company will review the study to determine if it would ask FDA to allow changes on the labeling of Premarin, which currently warns that the drug might increase risk of a heart attack (Wall Street Journal, 2/14). Ginger Constantine, Wyeth's vice president for women's health care, said that both the recent results from the WHI study and another recent study's results "clearly show no increased risk of coronary heart disease with estrogen-alone therapy" (Conlon, Reuters, 2/13). However, Arthur Levin, director of the advocacy group Center for Medical Consumers, said keeping the warning label as it is currently could prevent misuse of the drug, adding, "[FDA] wouldn't want to change it to overplay the benefit of a single study and downplay the body of all other research" (Ricks, Long Island Newsday, 2/14).

ABC's "World News Tonight" reported on the study. The segment includes comments from Manson and Lila Nachtigall of New York University School of Medicine (Stark, "World News Tonight," ABC, 2/13). The complete segment is available online in RealPlayer.

In addition, NPR's "All Things Considered" reported on the study. The segment includes comments from Manson and Hugh Taylor of the Yale University School of Medicine (Neighmond, "All Things Considered," NPR, 2/13). The complete segment is available online in RealPlayer.

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