Hormone Therapy and Heart Disease. Part 1

Posted by Lloyd on November 23, 2011
Health

THE STORY
Women approaching menopause face the difficult decision of whether or not to take hormone replacement therapy (HRT). Estrogen therapy is known to help stave off coronary heart disease and osteoporosis, but it’s also linked to an increased risk of breast cancer and endometrial cancer. Adding progestin to the hormone mix eliminates the endometrial cancer issue, so for most women the HRT decision involves balancing concerns about breast cancer and heart disease. According to a study in the April 9 Journal of the American Medical Association, women with coronary heart disease and those at risk of developing it could add up to three years to their lives by taking HRT.

Massachusetts researchers used a mathematical model to predict the effects of HRT on the life expectancy of a 50- year-old menopausal woman, taking into account risk factors and disease rates for coronary heart disease, breast cancer, hip fracture, and endometrial cancer. For women with at least one risk factor for coronary heart disease, such as high blood pressure, the researchers concluded that HRT’s benefits outweigh its risks. This held true even for women who were at increased risk for breast cancer because they had a mother or sister with the disease.

Does this mean that every woman with heart disease should take HRT?

A CARDIOLOGIST’S PERSPECTIVE

This study adds to a growing body of evidence suggesting that HRT can extend life for most postmenopausal women. The research technique used in this study, decision analysis, uses mathematical probabilities to estimate the risks and benefits of therapies, in this case HRT. But there are a couple of problems with this type of research.

First, decision analyses reach their conclusions by evaluating previously collected statistics, rather than following real people. The only way to prove whether HRT truly saves lives is to randomly divide a group of women in half, give hormones to one group and dummy pills (placebos) to the other, and then compare how many women are alive in each group after a follow-up period. Although such randomized, placebo-controlled trials are under way, we won’t have results for several years.

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