Hormone therapy has been discussed in the media in the past for its role in coronary heart disease prevention. Now new research comes to light that questions its benefits in this regard.

Over the years women who reach midlife have looked for ways to feel better and relieve the symptoms that this time of life can bring.

Many women turned to hormone replacement therapy as one answer. Its benefits were extolled in the media, and relief from hot flashes and osteoporosis looked good. Not only that, but studies such as the early Postmenopausal Estrogen/Progestin Interventions Trial (PEPI) suggested that it prevented heart disease.

But now newer clinical trials are challenging this assumption. It appears that hormone replacement therapy does not decrease the risk of heart disease in women who have preexisting risk factors, and in fact may increase the risk of a heart attack in this group.

What Is Hormone Replacement Therapy?

There are two major categories of hormone replacement therapy that are commonly prescribed. The first is estrogen replacement therapy (ERT), which is a synthetic or natural form of estrogen given in pill form or through a skin patch. It is often prescribed to relieve the symptoms of menopause and to prevent or treat osteoporosis.

The second category is called hormone replacement therapy (HRT), and is the combination of estrogen with small amounts of progestin. Progestin is added because some studies showed an increased amount of uterine cancer in women who took estrogen alone; progestin seems to prevent the uterine lining from building up which is one risk factor for this disease.

And now we are learning the effects of taking hormone replacements, both the benefits and the risks.

The Clinical Trials Report In

The Heart and Estrogen/progestin Replacent study (HERS) showed that women who took hormone replacement therapy had a higher risk of having a heart attack during the first year of therapy than those who took a placebo (one with no medication in it). This risk of heart attack decreased after the first year of taking hormone replacement.

Then the results of the Estrogen Replacement and Atherosclerosis (ERA) study came in: there was no heart benefit noted for women taking HRT. Next, the results of the Women’s Health Initiative showed that one percent of the women who were taking HRT in this study experienced an increased risk of heart attack, stroke, and blood clots early in the trial. This was in spite of lowered LDL (low density lipoprotein) and increased HDL (high density lipoprotein) cholesterol levels which were thought to offer protection from these conditions.

After the first year on HRT, this risk of heart attack or stroke decreased, and after several years there was no increased risk found for women in the study.

Lastly, the Women’s Estrogen for Stroke Trial (WEST) studied postmenopausal women with a history of stroke, to see if estrogen replacement therapy could prevent stroke. The results found that it did not prevent another stroke, and the women who took replacement estrogen had a greater risk of a severe stroke than women who took a placebo.

What makes these results so significant is the fact that for years, doctors were prescribing hormone replacement therapy for its preventive effect on heart disease. But these clinical trial results are showing that during the first year or two, a women with preexisting heart disease who is on HRT has an increased risk of a heart attack. In fact, the American Heart Association recently changed its stance in this regard, and states that women should not take HRT solely for the purpose of reducing the risk of heart disease after menopause or to lower their cholesterol level.

Other Risks of Hormone Replacement

Women at risk for blood clots also should not take HRT, since it has been shown to create an increased risk of deep vein thrombosis (clots in the deep veins of the legs) and pulmonary embolus (blood clots that break off and move into the lungs).

Another risk associated with estrogen replacement therapy (without added progestin) is an increased risk of endometrial cancer (cancer of the lining of the uterus) or uterine cancer. Adding progestin (such as with HRT) lowers this risk.

Both oral (pill) ERT and HRT can increase the risk of gallbladder disease, while the skin patch form of therapy does not.

ERT and HRT have also been linked to increased triglyceride (fatty acid) levels. Some studies have also found an increased risk of breast cancer for women on long-term estrogen therapy.

Because of these risks of hormone replacement, any woman who has medical conditions such as liver disease, a history of breast or uterine cancer (in themselves or close family), coronary heart disease or stroke, gallbladder disease, high blood pressure, severe obesity, diabetes, or a high risk of blood clots in the veins should let their doctor know since HRT increases the risk of serious complications.

Benefits of Hormone Replacement Therapy

Hormone replacement therapy does have some demonstrated benefits that need to be weighed against the risks that have been noted above. It does help relieve the symptoms of menopause and can prevent osteoporosis.

Currently, studies are ongoing on the effects of HRT in women who have no cardiac or clotting risk factors. Preliminary studies that are observational have found that there is not the same risk of heart disease or stroke in women without cardiac risk factors, and that estrogen may in fact lower the risk of stroke in these women.

While ERT and HRT do lower the levels of LDL (“bad cholesterol”) and increase the levels of HDL (“good cholesterol”), the American Heart Association advises against taking these hormones for this purpose. Instead, medications such as the “statins” that lower cholesterol levels are considered more effective.

Estrogen also helps keep arteries flexible and increases the blood flow through them, allowing them to respond better to exercise and physical stress.

And there is a natural type of estrogen that may have heart protective effects. 17beta-estradiol, a naturally occurring form of estrogen was shown to slow the progression of atherosclerosis in preliminary studies.

Other Ways To Prevent Heart Disease

In conclusion, the studies are showing that women with preexisting heart disease should not rely on hormone replacement therapy, which may in fact increase their chances of heart disease. Instead, women of all ages should focus on measures that can help prevent heart disease.

These include a healthy diet that is lower in saturated fat and cholesterol, moderate activity (as discussed and okayed with your physician), stopping smoking and maintaining a normal weight. Controlling other underlying conditions such as diabetes and blood pressure will also lower the risk of heart disease.

The earlier in life that risk factors are controlled, the better the chance that there will be a reduced risk of heart disease later in life, and the greater the opportunity to enjoy greater health.

heart disease, hormone therapy, prevention, replacement therapy