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New England Journal of Medicine August 24, 2000

New England Journal of Medicine August 24, 2000

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Posted by friend on August 30, 2000 at 03:41:19:

In Reply to: Re: Estrogen Therapy posted by Ken on August 26, 2000 at 09:38:21:

Hormone Replacement Does Not Reduce Heart Disease
Standard hormone replacement therapy (HRT), which is so often used in menopausal and post-menopausal women, does not protect them against heart disease after all, contrary to the belief of many physicians. A just published study in the New England Journal of Medicine saw no evidence that HRT had any effect on the rate of artery blockage.

Researchers performed angiographs to determine the amount of blockage in the arteries of 309 subjects with existing coronary artery disease at the beginning of the study, and then after they had been taking HRT or a placebo for an average of 3.2 years.

The group taking HRT was randomly assigned to either estrogen (horse derived) alone or estrogen with a progestin.

The 2 HRT groups both showed significant reductions in LDL cholesterol and elevations in HDL cholesterol:

9.4% decreased LDL and 18.8% increased HDL cholesterol for the estrogen-only group

16.5 percent decreased LDL and 14.2% increased HDL cholesterol for the estrogen-progestin group

However, neither treatment altered the progression of coronary atherosclerosis and the rates of cardiovascular events were also similar among the treatment groups.

The authors conclude that neither method of HRT "affected the progression of coronary atherosclerosis in women with established disease" and that "such women should not use estrogen replacement with an expectation of cardiovascular benefit."

Interestingly, in a separate study in the same issue, researchers at the Harvard University of Public Health state that an increase in postmenopausal hormone use, reduction of smoking and improved diet has resulted in significant reduction of cardiovascular risk, while the increase in the number of obese women has had the opposite effect.

Researchers looked at 85,941 participants in the Nurses' Health Study. They found that from 1980 to 1994:

Smoking declined by 41%

Hormone therapy increased by 175%

Diets became "healthier".

The number of overweight women grew by 38%.
The findings, the researchers state, "underscore the importance of diet and lifestyle in the primary prevention of coronary disease."

An accompanying editorial provides some interesting statistics on HRT. Elizabeth Nabel of the National Heart, Lung, and Blood Institute states that:

Evidence is mounting that current postmenopausal hormone preparations may not be effective as secondary prevention for some women. For example, the Heart and Estrogen/Progestin Replacement Study (HERS) (7) found that 4.1 years of treatment with conjugated estrogen plus medroxyprogesterone acetate had no overall effect on the rate of nonfatal myocardial infarction or death among women with established coronary artery disease. However, an increased risk of cardiovascular events was associated with the study regimen in the first year, (7) although an analysis of trends over time showed that the regimen had benefit in later years.

New England Journal of Medicine August 24, 2000; 343: 522-529, 530-537

COMMENT: Well here we have it. JAMA first documented that hormone replacement therapy does not help with heart disease and now NEJM confirms it with another study. If you are a woman and your physician is trying to convince of the need for hormone replacement therapy based on the reduction of your heart disease risk, please know that he is operating on old inaccurate information. The truth is that hormone replacement therapy does NOT decrease heart disease, it actually increases it.

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