Study Finds It Pays to be Heart Smart if Considering Hormone Therapy
A
research study has found that a simple blood test may indicate whether
post-menopausal hormone therapies present an elevated risk of a heart
attack. The study, part of the Women’s Health Initiative (WHI),
sponsored by the National Heart, Lung and Blood Institute of the
National Institutes of Health, was conducted in 40 centers nationwide
and included 271 cases of coronary heart disease in the first four
years of the trials of estrogen alone and of estrogen plus progestin.
Corresponding author Paul F. Bray, M.D., the Thomas Drake Martinez
Cardeza Professor of Medicine, Director, Division of Hematology at
Jefferson Medical College of Thomas Jefferson University and his
co-authors report their findings in the June 1st edition of the American Journal of Cardiology.
“Because
studies on hormone therapy have shown that they may increase heart
attacks and strokes, many women have been reluctant to use this
treatment,” said Bray. “However, because hormones remain the most
effective remedy for managing post-menopausal symptoms, such as hot
flashes and night sweats, many women wanted to take this therapy, but
have struggled with the decision because they feared the potential side
effects. We found that a simple and widely used blood test may be
useful to advise women if they are at an increased risk of a heart
attack while undergoing hormone therapy.”
The
study looked at levels of blood lipids and high sensitivity C-reactive
protein (hsCRP) in women who did not have any previous cardiovascular
disease. The results indicate those who entered the study with
favorable cholesterol levels were not at increased risk of developing
heart problems while taking hormones (estrogen alone or estrogen plus
progestin), whereas women with unfavorable cholesterol levels were at a
greater risk of having heart related complications. Specifically, women
with ratios of “bad” cholesterol to “good” cholesterol less than 2.5
did not appear to be at an increased heart disease risk when using
hormone therapy. On the other hand, it is known that women with higher
ratios of “bad” to “good” cholesterol were at higher risk of coronary
heart disease, and this study shows that risk is magnified if they take
hormone therapy. Elevated hsCRP appeared to predict higher risk in
women taking estrogen, but not in women taking estrogen plus progestin
compared to a placebo.
“This
report only considered the effects of hormone therapy on coronary
disease outcomes,” added Bray. “Instead of genetic testing or another
more complicated test, we wanted to find a simple and effective way to
assess the heart risk of hormone therapy. However, it should be noted
that the WHI investigators have not found this test helpful in
predicting the risk of stroke due to hormone therapy. It should also be
noted that hormones affect a number of major organs so patients must
consider the totality of health risks and benefits, including coronary
heart disease, stroke, venous thrombosis, breast cancer, fractures and
gall bladder disease. The findings do not change the current
recommendation that hormone therapy should not be used for prevention
of coronary heart disease – for prevention, women should focus on
preventing and treating known risk factors such as high blood
cholesterol and high blood pressure, and on avoiding smoking. Hormones
should be used for the shortest time and lowest dose need to obtain
symptom relief.”
The
WHI was established in 1991 to address the most common causes of death,
disability and impaired quality of life in postmenopausal women,
including cardiovascular disease, cancer, and osteoporosis. The WHI is
a long-term multi-million dollar endeavor, and one of the largest U.S.
prevention studies of its kind.
Media Only Contact:
Richard Cushman
Thomas Jefferson University Hospital
Phone: (215) 955-6300
Published: 5/22/2008