In the wake of recent study findings that hormone replacement therapy (HRT) may not protect older women's hearts as once thought, the American Heart Association (AHA) is cautioning doctors not to prescribe HRT for heart reasons alone.
In new guidelines issued Jul 23, the AHA states that women with cardiovascular disease should not be given HRT for the sole reason of preventing future heart attacks. In fact, its panel of experts advises, heart health should essentially be left out of HRT decisions for these patients.
The AHA panel based its advisory on the results of several studies of HRT and heart disease, including the Heart and Estrogen/progestin Replacement Study (HERS). That 4-year trial found that among women with heart disease, taking oral estrogen plus progestin actually raised the risk of recurrent heart attack and death during the first year of use, and thereafter lowered it only slightly.
Circulation July 24, 2001;104:499-503
Although estrogen does appear to lower cholesterol levels, heart disease prevention is clearly far more complex than cholesterol levels alone. It seems quite clear that estrogen supplementation in postmenopausal women who still have their ovaries does not lower the risk of heart disease.
Of course, if you have been a regular subscriber to this newsletter, you would have already known that by now, as that has been known for the last several years. However, now that the American Heart Association has announced that as its official policy in its journal (Circulation) we can now accept that the traditional medical paradigm has finally officially accepted this fact.
However, it will take many more years before all physicians learn this so don't be surprised if your regular doctor doesn't believe this or does not heed the AHA's advice.
There are other reasons to avoid estrogen, as it also increases the risk of gallbladder disease, venous thromboembolisms, (JAMA 1998 Aug 19;280:605-13) and breast cancer.
However, when a surgeon removes a woman's ovaries, she loses the primary sources of estrogen in her body. I will still routinely prescribe natural estrogens for women who have had their ovaries removed.
The other setting that they appear to be useful for in the short term is women with severe hot flashes that fail to respond to the food choice program or black cohosh. Sleep is vital to good health and if the hot flashes impair sleep, then the minor increase in disease risk is warranted in the short term, as sleep impairment will cause more serious health problems.
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Estrogen Does Not Reduce Heart Disease
Estrogne Hormone Replacement Therapy Raises Women's Heart Risks Hormone Replacement Does Not Reduce Heart Disease