Monday, July 23, 2001

Females over 50
alerted to heart risk

Doctors rethink giving hormones
to those with coronary disease

By Helen Altonn

Post-menopausal women diagnosed with heart disease or stroke should not start hormone replacement therapy, the American Heart Association cautioned today.

The AHA said its new position is based on recent scientific studies with conflicting results about the role of hormone replacement therapy in reducing risk of heart disease in women after menopause.

Heart disease is the No. 1 killer of women, points out Dr. Joana Magno, Honolulu cardiologist and AHA of Hawaii president.

"We've never known what to do," she said. "We think hormones are helpful to women in preventing heart disease, but studies are coming out saying for women who already have coronary disease, there may not be benefits."

Now, the heart association is advising women who have already had heart disease or stroke not to start hormone replacement therapy, she said.

For women on estrogen who had a heart or stroke problem in the past, the decision about stopping it must be made with a physician, taking into account other benefits and risks, Magno said.

Dr. Helen Petrovitch, University of Hawaii professor of medicine and former AHA of Hawaii president, said a Heart Estrogen Replacement Study (HERS) found cardiac events increased in the first year of hormone replacement therapy, but decreased in following years.

"At the end of four years, there was no difference between users and nonusers (of hormones)."

Another study looking at effects of estrogen replacement on arteriosclerosis found no improvement or progression of narrowing of blood vessels, she said.

A huge study also was done nationally of nurses who were followed for years and reported their health status to a data base, Petrovitch said.

It was an observational study, not a scientific clinical trial, but the results showed a slight increase in heart disease in the short term and a trend toward decreasing risk over time, she said.

"The important point," she said, "is if women are already on hormone replacement therapy and have a coronary event, it has to be decided on an individual base whether to continue."

Petrovitch said there are no firm recommendations about what to do for healthy women in terms of prescribing hormone replacement to prevent a first heart attack.

There is not enough evidence to suggest hormone replacement should be used only for that purpose, she said, adding that the decision should consider all possible benefits.

"Prevention of heart disease should weigh into that, but it shouldn't be the only reason."

Petrovitch is co-principal investigator for Women's Health Hawaii, part of a Women's Health Initiative by the National Institutes of Health.

It began in 1994 with a goal to recruit 164,500 women ages 50 to 79 to track their health to determine the roles lifestyle, genetics and environment play in health risks.

Hawaii's program began in 1995, and 400 to 500 women are participating in the hormone replacement part, Petrovitch said. Cardiovascular disease is the primary interest, she said.

It's too early to report the results, she said, but a safety monitoring board is looking at them, and no decision has been made to stop the trial early. "They're still weighing the pros and cons."

Magno said she is anxiously awaiting the results because the situation is not clear now and it's difficult to make decisions about hormone replacement therapy.

"It would be nice if one size fit all and we could say when they turn 50 or become menopausal, start on hormones, but it's not quite that simple yet. There is a lot to be considered."

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