Monday July 23 5:41 PM ET
NEW YORK (Reuters Health) - In the wake of recent study findings that hormone replacement therapy (HRT) may not protect older women's hearts as once thought, the American Heart Association (AHA) is cautioning doctors not to prescribe HRT for heart reasons alone.
In new guidelines issued Monday, the AHA states that women with cardiovascular disease should not be given HRT for the sole reason of preventing future heart attacks. In fact, its panel of experts advises, heart health should essentially be left out of HRT decisions for these patients.
For these women ``the issue about whether it protects your heart is a non-issue,'' the lead author on the panel's report, Dr. Lori Mosca of New York Presbyterian Hospital, told Reuters Health. The results from controlled trials now show that HRT does not cut the risk of heart attack and death for women with established heart disease, she said.
As for healthy postmenopausal women, it remains unclear if HRT can help prevent the onset of heart disease. So the panel advises that while these women can take heart health into consideration, HRT should ultimately be prescribed for its established benefits of reducing menopause symptoms such as hot flashes and preserving bone mass.
``Primarily the decision should be based on osteoporosis prevention and menopause symptoms,'' Mosca said, noting that these benefits must be weighed against the potential risks--namely, higher odds for blood clots, gallbladder disease and possibly breast cancer.
The HRT recommendations are published in the July 24th issue of Circulation: Journal of the American Heart Association.
The AHA panel based its advisory on the results of several studies of HRT and heart disease, including the Heart and Estrogen/progestin Replacement Study (HERS). That 4-year trial found that among women with heart disease, taking oral estrogen plus progestin actually raised the risk of recurrent heart attack and death during the first year of use, and thereafter lowered it only slightly.
And two studies released earlier this month confirmed this pattern of an early increased heart risk for women with established disease. Harvard investigators who conducted one of those studies concluded that women should not be prescribed HRT for the sole purpose of preventing second heart attacks.
Mosca noted that despite the early risk of heart attack and death found in these studies, there is not enough evidence to advise women with heart disease to stay away from HRT altogether. And heart disease patients who have been on hormones for a while and are happy with the therapy can keep it up, she said.
Experts still await the outcome of trials looking at HRT and the prevention of heart disease, the AHA panel points out. So for now it concludes that there is insufficient evidence to recommend HRT for preventing heart disease.
Researchers have long believed HRT may protect women's hearts for several reasons. For one, before menopause women have a lower risk of heart disease than men do, suggesting that their higher estrogen levels help shield the heart. In addition, HRT has been found to improve women's cholesterol levels, a key factor in heart disease risk.
There remains the possibility that HRT may yet cut the odds of developing heart disease in the first place, Mosca noted.
``I think there's still hope it will help,'' she said.
SOURCE: Circulation 2001;104:499-503.