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Hormone therapy doesn't slow heart disease, despite improvements in cholesterol

WINSTON-SALEM, N.C. -- In the full report of a major study of hormone replacement therapy (HRT) and heart disease, researchers from Wake Forest University Baptist Medical Center write in this week's New England Journal of Medicine that the treatment didn't slow the progression of heart disease in older women, despite improvements in cholesterol levels. The results of the study, the Estrogen Replacement and Atherosclerosis (ERA) trial, were first announced at the American College of Cardiology's annual meeting in March.

"The evidence suggests that women with heart disease should not use estrogen replacement therapy as a treatment for heart disease," said David Herrington, M.D., M.H.S., lead investigator.

ERA used cardiac catheterization, a test that injects dye into the arteries, to measure narrowing in the heart's arteries caused by a buildup of cholesterol. As vessel disease progresses, the arteries become smaller. A total of 309 older women with heart disease were randomly assigned to take estrogen (Premarin®), estrogen combined with a progestin (Prempro®), or a dummy pill (placebo). Sophisticated computer techniques were used to measure subtle changes in their arteries over the 3.2-year study period.

"Overall, there were no differences between the groups in how quickly the disease progressed," said Herrington, associate professor of Cardiology.

No effect was seen despite improvements in cholesterol. For the women taking estrogen alone, low-density "bad" cholesterol decreased an average of 9.4 percent and high-density "good" cholesterol increased by 18.8 percent. For women taking estrogen plus progestin, the changes were 16.5 percent for bad cholesterol and 14.2 percent for good cholesterol.

"Improved cholesterol levels from conventional cholesterol-lowering medications typically result in slowing of disease progression and fewer heart attacks," said Herrington. "But in this study, improvements in cholesterol with estrogen had
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Contact: Karen Richardson
krchrdsn@wfubmc.edu
336-716-4587
Wake Forest University Baptist Medical Center
22-Aug-2000


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