Cardiologists report on HRT

A second clinical study has shown that estrogen does not help women with heart disease. This finding, presented to a meeting of American cardiologists in March, counters a widespread assumption that estrogen benefits the cardio-vascular system of all women past menopause.

For women who must decide whether or not to take estrogen or hormone replacement therapy (ERT or HRT) after menopause, this latest report adds to the difficulty of making the right decision.

Two Canadian physicians with extensive research experience in women’s health offer reassurance. They say it’s important to look carefully at the specifics of the report-the study involved only women who already have heart disease. They say women with healthy hearts do get protection with estrogen. And they say it’s clear estrogen does guard against brittle bones and diminished mental capabilities.

But they admit the best answers about all forms of HRT won’t be known for another three to five years. That’s when results are due from a controlled clinical study of 27,000 American women in the Women’s Health Initiative. This is a multi-billion dollar study of women’s health sponsored by a number of agencies.

Mordetails on the latest HRT report:
Just over 300 women underwent treatment with either estrogen, a placebo, or both estrogen and progesterone. All the women had some signs of heart disease and just under half had already suffered a heart attack. Their average age was just under 66 years. They were assessed through angiograms.

After three years there were no differences amongst the groups. The hormone replacement therapy did lower cholesterol, but that didn’t translate into a measurable benefit for arteries in the heart.

The investigators, from Wake Forest University in North Carolina, were led by Dr. David Herrington. He says their report “adds to the growing body of evidence that once you have established disease, estrogen can’t reverse disease.”

But he did note that “it still leaves open the issue that estrogen may be helpful in preventive efforts.” This is the second clinical study to show that neither estrogen nor estrogen in combination with progesterone has any effect in slowing the progress of heart disease in women once it’s begun.

Two years ago, a much larger study with almost three thousand women had similar findings. This Heart and Estrogen/progestin Study (HERS) and the latest one Estrogen and Atherosclerosis (ERA) are the best sources to date of hard data, scientists agree.

Canadian HRT researchers react:
Dr. Ruth McPherson, a leading researcher in Canada in cardiovascular disease, says the ERA report confirms one thing doctors already knew. “For women with serious heart problems, estrogen or HRT is not the first line of treatment. The majority of women with heart disease require cholesterol reducing drugs and other medications to halt the progression of their disease.”

Dr. McPerson is a professor of medicine at the University of Ottawa and known for her special interest in women’s health. She also questions the reliance on angiograms to examine the hearts of the study participants “Angiograms are not sensitive enough to pick up small changes in the arteries if these occur with estrogen treatment. We do know estrogen improves the ability of arteries to dilate and has some beneficial effect on cholesterol concentrations.”

For healthy women with no heart disease, Dr. McPerson says estrogen or HRT does offer cardio-vascular protection. “But oral estrogen can also play a role in the formation of blood clots–which is a risk for a small percentage of healthy women and probaby a greater risk for women with heart disease.”

Dr. Bhagu Bhavnani is the director of research in the obstetrics and gynecology department at St. Michael’s Hospital in Toronto. He says that estrogen pills are the second biggest selling drugs in Canada, so he understands the keen interest in any test results.

One of his concerns is quality of life for women entering menopause and beyond. He estimates that in the next couple of decades, millions of menopausal and postmenopausal women will face a number of health challenges affecting their quality of life. He says the ERA and HERS studies help refine the use of hormone replacement therapy.

“HRT is not a cure-not for heart, or osteoporosis-but it’s a very important prevention of these conditions and for better quality of life. Also, the hot flashes, the night sweats, the mood changes-all these are helped by HRT. You can only eat so much soya (a natural source of estrogen).”

Dr. Bhavanni says no drug is risk free. With more hard data rolling in all the time, he says it’s important women do their homework about the benefits and risks of HRT, so they can make an informed decision.