Link to Heart Disease in Older Women Examined : 2 Studies Reach Opposite Findings on Estrogen

Two scientific papers examining the effects of estrogen on older women’s hearts reached the New England Journal of Medicine at almost the same time. One suggested that the hormone prevents heart disease, the other that it causes it.

Both studies were found to be valid, and both are being published in today’s issue of the journal. The conflicting results, experts say, hold lessons about how science works and what should be made of its conclusions.

“This illuminates that one should never take as gospel what is published in the New England Journal of Medicine but should take it as the current state of the art,” said Dr. Jay Winsten, assistant dean of the Harvard School of Public Health.

Sent Independently

Dr. Marcia Angell, deputy editor of the journal, said the papers were sent independently to outside experts for evaluation, and both appeared to be well done and worth publishing. So the weekly magazine ran them back to back.

“No study we publish came down to us on a tablet,” she said. “There’s always a possibility that something is missing or that something is wrong. I think it’s a nice reminder that science is fallible.”

Both studies rely on epidemiology, a research method that finds links between the way people live and the diseases they suffer. Experts examine the drugs people take, the food they eat or the things they do. Then the researchers see whether people’s habits correspond with the ills that befall them.

Increases Cancer Risk

Estrogen supplements relieve hot flashes and other unpleasant symptoms of the change of life. Epidemiological studies have shown that estrogen protects women from brittle bones but increases their risk of uterine cancer.

Since between 2 million and 3 million older women in the United States take estrogen, the pills’ potential effect on heart disease is also important.

1,234 Women Studied

Researchers at the Framingham Heart Study, a long-running survey of the health of residents in one community, considered 1,234 post-menopausal women who lived in the Boston suburb. They looked for an association between estrogen use and development of chest pain, heart attack or death from heart disease.

They found that the risk of heart disease was almost twice as high among women who took estrogen as among those who did not.

The other team, from Harvard Medical School, took a similar approach. They surveyed 121,964 female nurses and compared the incidence of heart attack and fatal heart disease among post-menopausal users and non-users of estrogen.

The risk of heart disease was less than a third as high among the women taking estrogen. The Harvard researchers concluded: “These data support the hypothesis that the post-menopausal use of estrogen reduces the risk of severe coronary heart disease.”