AHA Warns Against Using HRT for Cardio Benefits

DALLAS--The American Heart Association (AHA) released astatement warning physicians against prescribing women estrogen replacementtherapy (ERT) or hormone replacement therapy (HRT) for cardio-protectivebenefits. Published in the July 24 Circulation: Journal of the American HeartAssociation (104 (4):499-503, 2001) (http://circ.ahajournals.org), thisadvisory stated that there is inconclusive evidence that these therapies reducethe risk of coronary heart disease in postmenopausal women.

The risk of heart disease and stroke rises as a woman approaches menopause,which many have believed is due to decreasing levels of estrogen. Compared tomen, women have a delayed onset of heart disease by about 10 years, said LoriMosca, M.D., Ph.D., lead author of the advisory. It has been assumed [by themedical community] that this protection has been afforded to women because theyhave estrogen and men dont. At this time, there is not sufficientevidence to make that claim. [The intent of this advisory] is to clarify therole of hormones in heart disease prevention.

According to this report, there is insufficient data to conclusively suggestthat ERT or HRT should be initiated for the sole purpose of reducingcardiovascular risks. For healthy menopausal women, the advisory suggests othersways to decrease heart disease risk, such as not smoking, maintaining a healthyweight and increasing physical activity. Those menopausal women who already havecardiovascular disease should not use ERT or HRT unless their doctor suggestsotherwise.

Mosca also stated that the benefits of HRT/ERT (improving hot flashincidence, preventing osteoporosis) must be weighed against the risks for bloodclots, gallbladder disease and a possible increased risk for breast cancer. Forpostmenopausal women without heart disease, we do not suggest that HRT be takencompletely out of the equation, Mosca concluded. It can weigh into thedecision, it just shouldnt drive the decision for women without heartdisease.

In the meanwhile, two large, randomized studies are taking a more in-depthlook at HRTs effects on cardiovascular disease--the Womens HealthInitiative by the National Heart, Lung and Blood Institute (www.nhlbi.nih.gov/whi/)and the WISDOM study in England (www.wisdomenet.co.uk).