Hormones May Help Younger Women's Hearts
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Three years ago, women and their doctors were stunned by a huge study that found that hormone replacement therapy increased the risk of heart disease, stroke, and breast cancer. Many women stopped taking hormones right away. Now, new research is suggesting that in some women, hormone replacement does protect against heart disease.
NPR's Patricia Neighmond reports on the latest study in the Archives of Internal Medicine.
PATRICIA NEIGHMOND: The study analyzed data from over 10,000 women who had had hysterectomies. About half had taken estrogen, half did not. For women who started estrogen at a younger age, there was a reduction in heart attacks and heart disease.
Harvard Medical School's Dr. JoAnn Manson.
JOANN MANSON: We looked at total coronary heart disease, which included heart attack and coronary bypass surgery and angioplasty, and we found that among women aged 50-59, the women who were randomized to estrogen had a 34 percent lower risk overall than the women who were randomized to placebo.
NEIGHMOND: Older women between 60-79 saw no heart protection. Manson says this suggests that the timing of when therapy begins could be critical.
MANSON: The findings do suggest that women who are recently menopausal and who are in younger age groups can have some degree of reassurance that beginning hormone therapy for the purpose of treating their hot flashes, treating their night sweats, will not have an overall unfavorable effect. It should not increase their risk of heart disease, and may even provide some heart benefits.
NEIGHMOND: A literal flip-flop from earlier findings, which showed an actual increase in heart disease among women who took hormones. But Manson says we now know these were older women, on average 63, when they started hormones.
Yale University OB-GYN Hugh Taylor specializes in reproductive endocrinology. Taylor says that at 63, these women might have already been in the early stages of heart disease, with plaque buildup and hardening of the arteries.
Estrogen can't reverse heart disease, he says, but now there's suggestion that it could indeed prevent it. Taylor's doing a study that could answer the question once and for all. He's following women at the beginning of menopause and assigning them to hormone therapy or a placebo.
HUGH TAYLOR: We're going to look at their coronary arteries and their calcium in the coronary arteries, which is predictive of the development of atherosclerosis. And we're going to look at their carotid arteries with Doppler ultrasound and look for develop of atherosclerosis and the ability of estrogen to prevent that.
NEIGHMOND: Two other studies will also look at younger women and heart disease. Dr. Manson says estrogen has several biological effects that could translate into a lower risk of heart disease.
MANSON: For instance, we know that estrogen lowers the bad LDL cholesterol and increases the good HDL cholesterol. There's some evidence that it improves the elasticity of the blood vessel and makes it easier for the blood vessel to dilate. There's some evidence that it has an antioxidant effect.
NEIGHMOND: At the same time, there are known risks of estrogen. It increases blood clotting and inflammation, so clearly, Manson says, women who already have heart disease should not begin hormone therapy. A blood clot in an already narrowed artery could result in a heart attack.
Manson says the pendulum has definitely not swung back completely to the notion that women should take hormones to prevent heart disease. There's not enough evidence, she says, to say that. And increases in breast cancer risks still remain a concern for women on hormones. Clearly, women should discuss that risk with their doctor before taking hormone therapy.
Patricia Neighmond, NPR News.
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