Study: False alarm raised on estrogen
Study: False alarm raised on estrogen
By Thomas H. Maugh II
Copyright © 2007, Chicago Tribune
Published June 21, 2007
Nearly five years after government scientists told women that taking estrogen replacement therapy increased their risk of heart attacks and strokes, researchers have concluded that the drugs are beneficial for many after all.
Continuing analysis of the original data indicates that the researchers raised a false alarm for most women and that, if women begin taking the hormones shortly after menopause, the drugs do not raise the risk of heart disease and, in fact, might lower it.
The latest piece of evidence, in Thursday's New England Journal of Medicine, shows that taking estrogen for seven years or more after menopause reduces calcification of the arteries -- one of the key indicators of atherosclerosis -- by as much as 60 percent. High levels of calcification are generally considered a predictor of increased risk for a heart attack.
The only group of women at significant risk from the drugs are those who delay taking them for at least 10 years after menopause, experts said.
The findings "provide some additional reassurance for women who have been denying themselves relief" from hot flashes and other symptoms of menopause, said Dr. JoAnn Manson of Brigham and Women's Hospital in Boston, who led the original study and the one to be published Thursday.
Virtually all researchers agree that women should not hesitate to use hormone replacement therapy, commonly called HRT, to mitigate their symptoms when menopause begins. The debate is over how long they can safely do so.
Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, which sponsored the studies, said the new findings "do not alter the current recommendations that when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible, and hormone therapy should never be used to prevent heart disease."
But Dr. Howard Hodis, director of the atherosclerosis research unit at the University of Southern California medical school, countered that "there is absolutely no evidence -- none, zero -- that if you start a woman on estrogen at menopause and continue until she is 80, the risk goes up as she gets older." There is a higher risk of breast cancer with age for estrogen plus progestin, Hodis said at a news conference Tuesday sponsored by Wyeth Pharmaceuticals, but even then it is unclear whether the risk outweighs the benefits.
The new study involved a subset of 1,064 women age 50 to 59 in the Women's Health Initiative study who had undergone surgically induced menopause through a hysterectomy. Half were randomized to receive a Wyeth-produced estrogen, Premarin, and half a placebo.
The women were on the drugs for an average of 7 1/2 years. About a year after the study was stopped, physicians measured the buildup of calcium deposits in their blood vessels.
Overall, they found, women taking estrogen had 42 percent less calcification of their arteries. Women who had taken at least 80 percent of their daily doses of the drug had 61 percent less calcification.
The results were "clear and striking," Drs. Michael Mendelsohn and Richard Karas of the Tufts University School of Medicine wrote in an editorial accompanying the study. "Now, some clarity about hormone replacement therapy and heart disease is emerging."
Researchers now say the benefits of estrogen replacement occur only if it is started before atherosclerosis begins to develop. Once hardening of the arteries has set in, estrogen is known to produce damaging effects.
- - -
5 years of findings Continuing analysis of the federal Women's Health Initiative has yielded these key findings:
July 2002: Women taking estrogen with progestin have higher rates of breast cancer.
May 2003: In women 65 and older, taking hormones for years raises the risk of Alzheimer's.
September 2003: Estrogen-progestin pills do not reduce -- and might increase -- the risk of ovarian cancer.
March 2004: Women taking estrogen alone had an increased risk of stroke, and possibly more dementia.
April 2007: Hormones do not raise heart attack risks for women in their 50s, but do raise breast cancer and stroke risks.
May 2007: Those who take hormones before age 65 reduce their risk of dementia by half.
June 2007: Women who take hormones in their 50s have a lower risk for hardening of the arteries.
By Thomas H. Maugh II
Copyright © 2007, Chicago Tribune
Published June 21, 2007
Nearly five years after government scientists told women that taking estrogen replacement therapy increased their risk of heart attacks and strokes, researchers have concluded that the drugs are beneficial for many after all.
Continuing analysis of the original data indicates that the researchers raised a false alarm for most women and that, if women begin taking the hormones shortly after menopause, the drugs do not raise the risk of heart disease and, in fact, might lower it.
The latest piece of evidence, in Thursday's New England Journal of Medicine, shows that taking estrogen for seven years or more after menopause reduces calcification of the arteries -- one of the key indicators of atherosclerosis -- by as much as 60 percent. High levels of calcification are generally considered a predictor of increased risk for a heart attack.
The only group of women at significant risk from the drugs are those who delay taking them for at least 10 years after menopause, experts said.
The findings "provide some additional reassurance for women who have been denying themselves relief" from hot flashes and other symptoms of menopause, said Dr. JoAnn Manson of Brigham and Women's Hospital in Boston, who led the original study and the one to be published Thursday.
Virtually all researchers agree that women should not hesitate to use hormone replacement therapy, commonly called HRT, to mitigate their symptoms when menopause begins. The debate is over how long they can safely do so.
Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, which sponsored the studies, said the new findings "do not alter the current recommendations that when hormone therapy is used for menopausal symptoms, it should only be taken at the smallest dose and for the shortest time possible, and hormone therapy should never be used to prevent heart disease."
But Dr. Howard Hodis, director of the atherosclerosis research unit at the University of Southern California medical school, countered that "there is absolutely no evidence -- none, zero -- that if you start a woman on estrogen at menopause and continue until she is 80, the risk goes up as she gets older." There is a higher risk of breast cancer with age for estrogen plus progestin, Hodis said at a news conference Tuesday sponsored by Wyeth Pharmaceuticals, but even then it is unclear whether the risk outweighs the benefits.
The new study involved a subset of 1,064 women age 50 to 59 in the Women's Health Initiative study who had undergone surgically induced menopause through a hysterectomy. Half were randomized to receive a Wyeth-produced estrogen, Premarin, and half a placebo.
The women were on the drugs for an average of 7 1/2 years. About a year after the study was stopped, physicians measured the buildup of calcium deposits in their blood vessels.
Overall, they found, women taking estrogen had 42 percent less calcification of their arteries. Women who had taken at least 80 percent of their daily doses of the drug had 61 percent less calcification.
The results were "clear and striking," Drs. Michael Mendelsohn and Richard Karas of the Tufts University School of Medicine wrote in an editorial accompanying the study. "Now, some clarity about hormone replacement therapy and heart disease is emerging."
Researchers now say the benefits of estrogen replacement occur only if it is started before atherosclerosis begins to develop. Once hardening of the arteries has set in, estrogen is known to produce damaging effects.
- - -
5 years of findings Continuing analysis of the federal Women's Health Initiative has yielded these key findings:
July 2002: Women taking estrogen with progestin have higher rates of breast cancer.
May 2003: In women 65 and older, taking hormones for years raises the risk of Alzheimer's.
September 2003: Estrogen-progestin pills do not reduce -- and might increase -- the risk of ovarian cancer.
March 2004: Women taking estrogen alone had an increased risk of stroke, and possibly more dementia.
April 2007: Hormones do not raise heart attack risks for women in their 50s, but do raise breast cancer and stroke risks.
May 2007: Those who take hormones before age 65 reduce their risk of dementia by half.
June 2007: Women who take hormones in their 50s have a lower risk for hardening of the arteries.
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