July 23, 2001
The influential American Heart Association is changing course dramatically and recommending that women not be prescribed estrogen-replacement therapy (i.e.. Premarin, Prempro) to prevent heart disease and strokes, because of growing evidence that it may not help and might even cause serious harm.
Doctors long believed that hormone supplements are good for women's hearts.
But the heart association, one of the most authoritative organizations in the field of heart disease prevention, cited conflicting evidence that has come out over the past few years.
"We don't really believe that there's sufficient data right now to really encourage a woman to take hormone replacement therapy for the purpose of the prevention of heart disease," said lead author of the guidelines, Dr. Lori Mosca, Director of Preventive Cardiology at New York Presbyterian Hospital of Columbia and Cornell Universities.
Dr. Cynthia Drauze of Mount Sinai Medial Center, in New York, called the new report a "reality check."
"Hormone replacement was definitely promoted widely as an overwhelming benefit in treatment of heart disease," she said.
The largest ever study designed to clarify HRT'S (Hormone Replacement Therapy) role in heart disease has found that the total number of heart attacks, strokes and blood clots remained HIGHER in those on HRT than those on a placebo after four years of treatment.
"Recent clinical trials have convinced most scientists that HRT does not protect women with existing heart disease from additional heart problems," says Dr. Mosca in the study which was published today in the scientific journal "Circulation."
There is no question that hormone replacement therapy treats the symptoms of menopause such as hot flashes and mood swings. The big debate is about the secondary effects – estrogen replacement therapy was only recently confirmed as being a major triggering element in breast cancer and endometrial cancer and now this research confirms another major concern – an increase in heart disease.
Dr. JoAnn E. Manson, Chief of Preventive Medicine at Harvard's Brigham and Women's Hospital, estimated that at least 20% of women taking hormone replacement therapy are doing so expressly to prevent heart disease. Manson, co-author of a recent New England Journal of Medicine article that advised doctors not to prescribe hormones just to prevent heart disease, said the figure was once twice as high, but fell in recent years as more studies questioned the benefits and suggested negative effects.
"I think it has dropped but not nearly enough, " Manson said. "There are still many clinicians out there who are prescribing hormone replacement therapy for the express purpose of preventing heart disease."
Associated Press, USA Today, and NBC news sources. July 23, 2001.