Estrogen Therapy Could Have Some Heart Benefits
Post-menopausal estrogen therapy does not appear to protect women in their 60s and older from heart disease, but researchers say it may have some protective effect for women in their 50s.
The Women’s Health Initiative, which conducted the research, stopped the analysis in March 2004 because of a higher risk of stroke among women taking estrogen. But further examination of the data shows that, at least for women between 50 and 59, the hormone may provide a boost to heart health. Researchers did not examine stroke risk.
Given the new findings, some experts said Food and Drug Administration warnings in package inserts of estrogen pills might be too stringent. The inserts summarize problems such as the higher propensity for blood clots and strokes.
Other experts remarked that the results were not a ringing endorsement. It would be reckless, they say, to return to promoting estrogen as a cure-all.
“We feel that our data are completely consistent with the current American Heart Assn. guidelines and the current FDA guidance to use the lowest possible dose for the shortest possible duration,” said Dr. Judith Hsia, a professor of medicine at George Washington University, lead investigator of the Women’s Health Initiative’s research on estrogen therapy and its effects on the heart.
Currently, estrogen therapy alone, or in combination with progestin, is prescribed to abate moderate to severe menopausal symptoms, such as hot flashes.
Research participants took either estrogen or a placebo. Only those who’d had hysterectomies were chosen because of estrogen’s link to uterine cancer.
Hsia found that 201 estrogen takers required bypass surgery or angioplasty; had heart attacks, episodes of angina or died from a cardiac problem, compared with 217 on a placebo who had related heart events.
More than 10,700 women were in the study.
But among the 1,396 women between 50 and 59, heart problems were so dramatically less frequent that researchers attributed it to the daily dose of estrogen. The study is reported in today’s Archives of Internal Medicine.
Dr. Lila Nachtigall, a professor of obstetrics and gynecology at New York University Medical Center in Manhattan, said the findings should be reflected in the labeling of Premarin, the most widely prescribed estrogen pill in the United States.
“One of the things that’s frightening to doctors is to have this package insert,” Nachtigall said. “And of course for the patient it is frightening to read that warning. “
Whether to take estrogen or combination hormone therapy has been a difficult decision for women approaching menopause, in light of the steady stream of studies that has poured from the Women’s Health Initiative in recent years. In 2002, investigators found that combination pills of estrogen and progestin raised the risk of breast cancer, heart attack and stroke.
The initiative is a massive series of studies examining the effects of hormone therapy, diet modification and calcium and vitamin D supplements during the post-menopausal years.
Arthur Levin, director of the Center for Medical Consumers, an advocacy organization in Manhattan, said keeping the label strong prevented the misuse of hormone therapy.
“I think the issue here is that you want the labeling to reflect the most current science,” Levin said. “But at the same time you wouldn’t want to change it to overplay the benefit of a single study and downplay the body of all other research.”
