Research: Hormone Replacement Therapy Doesn't Protect Hearts, Does
Increase Risk for Blood Clots and Gallbladder Disease
Women with heart
disease going through menopause who are taking hormone replacement therapy
(HRT) in hopes of preventing future coronary problems will not take
heart in new research reported in the July 3rd issue of JAMA (the Journal
of the American Medical Association).
"We concluded that estrogen
and progesterone therapy provides no coronary benefit and may cause
harm," says Nanette Wenger, M.D., chief of cardiology at Grady Hospital
and Professor of Medicine at Emory University School of Medicine. Dr.
Wenger is co-author of the paper which reports on HERS II (Heart and
Estrogen/Progesterone Replacement Study).
Results of HERS II show that
HRT offers no protection from heart disease. While researchers found
no increased risk of cancer linked to HRT, they did note a significant
increase in the risk of venous thromboembolism (blood clots) and gall
bladder disease. "We found a two fold increase in venous thromboembolism
with the greatest risk in the first two years of therapy. We also found
an almost 50% risk in gallbladder disease requiring surgery," says Dr.
Wenger co-author of the JAMA paper and principal investigator for the
HERS II study at Emory.
HERS II grew out of the landmark
clinical trial, HERS, reported in l998, which examined the effect of
conjugated equine estrogen plus progesterone (medroxyprogesterone acetate)
on coronary risk. HERS investigators studied 2,763 menopausal women
with documented coronary disease. After four years, they found no difference
between hormone treated and placebo treated women in the occurrence
of non- fatal or fatal heart events. "In fact, further analysis of the
original paper suggested an increased risk of coronary events during
the first year of treatment , but a decreased risk in years three to
five," notes Dr. Wenger, who was also a co-investigator of the original
HERS II was designed to find
out if the risk reduction noted after several years of HRT usage persisted.
Investigators followed 93% of the surviving research subjects from the
initial HERS, 2321 women, who agreed to an unblinded follow-up . At
the end of almost 7 years, HERS II researchers found no reduction in
coronary events - including heart attacks - compared with the placebo
"Certainly, hormone therapy
is the best therapy for menopausal symptoms and it is good for the prevention
of osteoporosis - the only two conditions for which it is licensed by
the FDA," says Dr. Wenger. "However, the new HERS II findings indicate
that, as recommended by the American Heart Association, menopausal hormone
therapy should not be used to reduce the risk of cardiovascular events
in women with coronary disease."