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Senior Citizen Health & Medicine
New Study Confirms HRT Does Not Benefit Older Women
No disease prevention benefit, but some potential
risk starting HRT many years after menopause
 July 11, 2007 – It is just one more nail in a
coffin that has already been shut on the use of hormone replacement
therapy (HRT) for older women. The British Medical Journal today
published on bmj.com new evidence that it should not be prescribed to
women many years past menopause to help prevent chronic conditions, such
as heart disease.
But the authors support the view that HRT is a safe
short term treatment for younger women in early menopause to relieve
symptoms and improve quality of life.
In 2002, the Women’s Health Initiative (WHI) trial
found that postmenopausal women taking HRT had more heart attacks and
strokes than non-HRT users. The trial was halted early and millions of
women around the world stopped taking HRT. But scientists now believe
that these risks may only apply to older women who do not normally use
HRT.
In 1999, another trial (WISDOM) began to assess the
long-term risks and benefits of HRT after the menopause. This trial was
also stopped after the first WHI results appeared, but the WISDOM
findings, published today, make an important contribution to the body of
knowledge about HRT when it is initiated in older postmenopausal women.
The WISDOM team identified 5,692 healthy women
registered at general practices in the UK, Australia and New Zealand
with an average age of 63 years and 15 years after the menopause.
The women who had not had a hysterectomy were split
at random into two groups. One was given a daily dose of combined
hormone therapy (estrogen and progestogen) and the other group was given
a placebo pill. Women who had had a hysterectomy were split between
combined hormone treatment, estrogen only and a placebo.
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HRT Increases Risk for Breast Cancer, Heart
Disease, Stroke
In the years before and during menopause, the
levels of female hormones can go up and down. This can cause symptoms
such as hot flashes and vaginal dryness. Some women take hormone
replacement therapy (HRT) to relieve these symptoms. HRT may also
protect against osteoporosis.
However, HRT also has risks. It can increase your
risk of breast cancer, heart disease and stroke. Certain types of HRT
have a higher risk, and each woman's own risks can vary depending upon
her health history and lifestyle. You and your health care provider need
to discuss the risks and benefits for you. If you do decide to take HRT,
it should be the lowest dose that helps and for the shortest time
needed. Taking hormones should be re-evaluated every six months.
-- National Heart, Lung, and Blood Institute
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All women were monitored for an average of 12
months and main outcomes such as cardiovascular disease, osteoporotic
fractures, breast cancer and deaths, were recorded.
There was a significant increase in the number of
major cardiovascular events (angina, heart attack or sudden coronary
death) and blood clots (venous thromboembolisms) in the combined hormone
therapy group compared to the placebo group. However, rates for
cerebrovascular disease, breast or other cancers, fractures and overall
deaths were not significantly different in these two groups.
This study confirms an early increase in
thromboembolic and cardiovascular risk in older women starting hormone
replacement therapy many years after the menopause, say the authors.
It shows that there is no overall disease
prevention benefit, and some potential risk, for women who start hormone
replacement therapy many years after menopause.
The results are also consistent with the early
findings of the WHI and other trials, and support the conclusion that
combined estrogen and progestogen therapy should not be initiated to
prevent cardiovascular disease in older postmenopausal women.
However, the authors stress that these results
cannot necessarily be applied to younger menopausal women starting
hormone replacement therapy to relieve symptoms such as hot flushes and
night sweats. For these women, recent studies suggest there may be
cardiovascular benefits of taking HRT around the time of menopause. The
authors say that more research is needed to assess conclusively the long
term benefits and risks among these women.
Those helping women make choices about treatment
should consider both the results and limitations of the WHI and WISDOM
trials, particularly those women who may be influenced by the timing of
initiation of hormone replacement therapy, they conclude.
In an accompanying editorial, Dr Helen Roberts at
the University of Auckland says that this study does not change current
advice to postmenopausal women. Healthy women in early menopause are
unlikely to face substantially increased risks when using hormones for a
few years, she writes. However, long term use of hormone replacement
therapy to prevent chronic disease is no longer recommended as the
available randomized evidence shows that the negative outcomes outweigh
the positive benefits.
Hormone Replacement Therapy is also called Estrogen
replacement therapy, HRT, Menopausal hormone therapy
Source: Women’s International Study of long
Duration Estrogen after Menopause (WISDOM): a multi-centre randomized
controlled trial of hormone replacement therapy in postmenopausal women
- Main Morbidities BMJ Online First
Facts about women and cardiovascular diseases
American Heart Association
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Lifestyle Changes Help Older Women's Hearts After
HRT
Healthy
eating and exercise helps ease cardiovascular disease risk in
postmenopausal women who've stopped using hormone replacement therapy
(HRT), a U.S. study released on May 15 says.
Researchers at the University of Pittsburgh
Graduate School of Public Health looked at 240 women who were taking HRT
at the start of the study: 134 of the women were put in a lifestyle
change group, while the other 106 were put in a health education group.
Compared to the women in the health education
group, those in the lifestyle change group showed significantly greater
reductions in weight, body mass index, waist circumference, total
cholesterol and LDL ("bad") cholesterol. The women in the lifestyle
change group were also more physically active and had healthier fat
intake.
Women in the health education group who stopped HRT
had an average increase of more than 22 mg/dL in total cholesterol and
LDL cholesterol, while those who stayed on HRT had average increases of
less than 4 mg/dL. No such differences were noted in the lifestyle
change group.
The study in the June issue of the
American Journal of Preventive Medicine.
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● Cardiovascular disease (CVD) ranks first among
all disease categories in hospital discharges for women.
● Nearly 39 percent of all female deaths in America occur from CVD,
which includes coronary heart disease (CHD), stroke and other
cardiovascular diseases.
● CVD is a particularly important problem among minority women. The
death rate due to CVD is substantially higher in black women than in
white women.
● In 2003, CVD claimed the lives of 483,842 females; cancer (all forms
combined) 267,902.
● In 2003, coronary heart disease claimed the lives of 233,886 females
compared with 41,566 lives from breast cancer and 67,894 from lung
cancer.
● 38 percent of women compared with 25 percent of men will die within
one year after a heart attack.
● Stroke is a leading cause of serious, long-term disability; an
estimated 15 to 30 percent of stroke survivors are permanently disabled.
● Misperceptions still exist that CVD is not a real problem for women.
Women lack understanding of their risks
A 2003 American Heart Association study of over 1,000 women conducted by
Harris Interactive, Inc., revealed the lack of understanding women have
of the dangers of heart disease and stroke. According to the results, a
mere 13 percent of women in America believe that heart disease and
stroke are the greatest health threat to women. This reveals the lack of
knowledge and understanding a majority of women have for their most
serious health threat. In addition, despite the fact that minority women
face the highest risk of death from heart disease and stroke, they have
lower risk factor awareness.
Important facts about women's risk, diagnosis and
treatment
● Risk of heart disease and stroke increases with
age, and in the year 2003, over 45 million American women were 50 and
older.
● More women than men die of stroke.
● Low blood levels of "good"
cholesterol (high density lipoprotein or HDL) appear to be
a stronger predictor of heart disease death in women than in men in the
over-65 age group; high blood levels of
triglycerides (another type of fat) may be a particularly important
risk factor in women and the elderly.
● Regular physical activity and a healthy weight reduce the risk of
non-insulin-dependent
diabetes, also called type 2 diabetes, which appears to be an even
stronger contributing risk factor for heart disease in women than in
men.
● Diagnosis of heart disease presents a greater challenge in women
than in men.
>>
More from American Heart Association
For more information:
>> Women’s Health Initiative (http://www.nhlbi.nih.gov/whi)
>> WHI Estrogen-Alone Study (http://www.nhlbi.nih.gov/whi/estro_alone.htm)
>> Menopausal Hormone Therapy Information (NIH) (www.nih.gov/PHTindex.htm)
>> Facts About Menopausal Hormone Therapy (http://www.nhlbi.nih.gov/health/public/heart/other/pht_fact.htm)
>> The Heart Truth for Women (http://hearttruth.gov)
>> The Healthy Heart Handbook for Women (http://www.nhlbi.nih.gov/health/public/heart/other/hhw/index.htm)
>> U.S. Health and Human Services Website on
Women’s Health (http://www.womenshealth.gov/)
>> American Heart Association has more about
women and cardiovascular disease.
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