Postmenopausal hormone therapy offers no protection against heart attacks

Although therapy with hormones was once thought to protect women's hearts after menopause, a UCSF-led study has found that, at least for women with heart disease, estrogen plus progestin therapy does not reduce the risk of heart attack or death.

The July 3, 2002 issue of the Journal of the American Medical Association (JAMA) contains two articles with the results of the Heart and Estrogen/Progestin Replacement Follow-up Study (HERS II).

HERS was a randomized, blinded trial to determine the effects of estrogen plus progestin (compared with placebo) in older postmenopausal women with heart disease. In 1998 HERS scientists reported that, surprisingly, risk of heart attack increased in the hormone therapy group during the first year of HERS. The risk seemed to decrease in the next several years, leading to the HERS II follow-up study to evaluate the effects of longer-duration hormone therapy.

The trend toward a reduced risk of heart attacks did not persist with additional follow-up. During almost 7 years, combining HERS and HERS II, there was no reduction in risk among women taking hormones.

"This follow-up study found no reduction in risk of heart attacks or death for women with heart disease during up to seven years of hormone therapy. Not only was there no cardiovascular benefit, there were adverse affects, including blood clots and gallbladder disease," said Deborah Grady, MD, MPH, UCSF professor of epidemiology and medicine and co-principal investigator on the studies. Grady is also director of the UCSF/Mount Zion Women's Health Clinical Research Center.

The hormone therapy caused a 2-fold increase in the risk of blood clots in the legs and lungs, with most of the increased risk in the early years of treatment, according to principal investigator Stephen Hulley, MD, MPH, professor and chair of the UCSF department of epidemiology and biostatistics. There was a nearly 50 percent increase in the risk of gallbladder disease r

Contact: Maureen McInaney
University of California - San Francisco

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