AHA Warns Against Using HRT for Cardio Benefits

DALLAS--The American Heart Association (AHA) released a statement warning physicians against prescribing women estrogen replacement therapy (ERT) or hormone replacement therapy (HRT) for cardio-protective benefits. Published in the July 24 Circulation: Journal of the American Heart Association (104 (4):499-503, 2001) (http://circ.ahajournals.org), this advisory stated that there is inconclusive evidence that these therapies reduce the 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 to men, women have a delayed onset of heart disease by about 10 years," said Lori Mosca, M.D., Ph.D., lead author of the advisory. "It has been assumed [by the medical community] that this protection has been afforded to women because they have estrogen and men don't. . At this time, there is not sufficient evidence to make that claim. [The intent of this advisory] is to clarify the role of hormones in heart disease prevention."

According to this report, there is insufficient data to conclusively suggest that ERT or HRT should be initiated for the sole purpose of reducing cardiovascular risks. For healthy menopausal women, the advisory suggests others ways to decrease heart disease risk, such as not smoking, maintaining a healthy weight and increasing physical activity. Those menopausal women who already have cardiovascular disease should not use ERT or HRT unless their doctor suggests otherwise.

Mosca also stated that the benefits of HRT/ERT (improving hot flash incidence, preventing osteoporosis) must be weighed against the risks for blood clots, gallbladder disease and a possible increased risk for breast cancer. "For postmenopausal women without heart disease, we do not suggest that HRT be taken completely out of the equation," Mosca concluded. "It can weigh into the decision, it just shouldn't drive the decision for women without heart disease."

In the meanwhile, two large, randomized studies are taking a more in-depth look at HRT's effects on cardiovascular disease--the Women's Health Initiative by the National Heart, Lung and Blood Institute (www.nhlbi.nih.gov/whi/) and the WISDOM study in England (www.wisdomenet.co.uk).