Hormone Therapy and Heart Disease. Part 2

Posted by Lloyd on November 23, 2011

A second problem with this study is that, lacking alternatives, it used data from studies that compared women who chose to take hormones with women who did not. Research suggests that women who choose HRT tend to also follow a healthy lifestyle, making it impossible for us to know how much of the apparent benefit is due to HRT and how much is due to lifestyle factors such as a good diet.

While we await conclusive research, what do I advise my women patients? I encourage the vast majority to take HRT. Even though studies to date, including this one, fall short of proof, the weight of evidence is that women who take HRT live longer. HRT appears to halve the risk of dying from heart disease – the number one cause of death in US women. Although HRT may increase a woman’s risk of breast cancer by 30 percent, this cancer is not as common as heart disease. Thus, any increase in breast cancer deaths is likely dwarfed by the huge decrease in heart disease deaths. While this type of reasoning is helpful when looking at risk across a whole population of women, it doesn’t necessarily apply to an individual woman. For example, a woman taking HRT may well die of heart disease, even though statistically her risk is reduced. I advise my patients based on their individual risk factors and their personal preferences.

I ask my women patients with coronary artery disease to consider HRT one of their heart drugs, because it should decrease the chances that they will have a heart attack or need angioplasty or bypass surgery in the future. And it should allow them to live longer. For women without heart disease but with even one risk factor — high blood pressure, high cholesterol, a family history of heart disease, or smoking — I recommend HRT as well.

Several of my patients are long-term breast cancer survivors who have gone on to suffer a heart attack later in life. For these women, the decision to take HRT is a very difficult one because of the fear that their cancer will recur. But once a woman has heart disease, her chances of dying from it are overwhelmingly high. Based on this, I have recommended HRT even to these patients.

I don’t recommend HRT for women with absolutely no risk factors for heart disease who have a family history of breast cancer. For these women, even a slight increase in the risk of breast cancer tips the scales away from HRT.

Even so, statistics about risk factors can guide the discussion only so far. In the end, a woman’s decision comes down to personal preference. Quantity of life does not always correlate with quality of life, and the nagging fear of cancer may weigh on some women too heavily to allow them to take HRT. These women can be assured that quitting smoking, exercising regularly, and lowering their cholesterol will all add years to their lives as well.

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