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Heart Association Advises Against Estrogen Use Solely for Cardiovascular Effects

Kate Traynor

Hormone replacement therapy does not prevent myocardial infarction or stroke in women with established cardiovascular disease and should not be factored into treatment decisions related solely to heart disease, according to a statement released in late July by the American Heart Association (AHA).

Evidence supporting this view, which is a reversal of AHA’s previous stance recommending hormone replacement therapy for women with heart disease, appeared in the organization’s peer-reviewed journal Circulation.1

The report emphasized that hormone replacement therapy, typically consisting of estrogen and a progestin, can be appropriate for relieving postmenopausal symptoms. In general, women whose menopausal symptoms are eased by hormone replacement therapy need not quit, said AHA. But women and their health care providers should not consider possible improvements in cardiovascular health a reason to start hormone replacement therapy.

Clinical trial findings denying the protective cardiovascular effects of hormone replacement therapy are strongest in studies of women who already have heart disease. In fact, evidence suggests that hormone replacement therapy may actually increase the frequency of myocardial infarction or stroke, at least during the first years of therapy. AHA now advises women with heart disease who use hormone replacement therapy to consider stopping the treatment if they become immobilized or suffer a coronary event or stroke.

According to the Circulation article, there is little definitive data available from studies examining whether hormone replacement therapy can prevent cardiovascular problems in women who do not have heart disease. But data from an ongoing, 15-year project indicates that recipients of hormone replacement therapy had more strokes, blood clots, and myocardial infarctions during the first two years of therapy than did placebo users.

Instead of relying on hormone replacement therapy to decrease the risk of cardiovascular events, women who have heart disease should make lifestyle changes that decrease the likelihood of such events, said AHA. Drug therapies to control dyslipidemia and hypertension are indicated when lifestyle modifications fail to bring serum lipid concentrations and blood pressure into acceptable ranges.

AHA noted that physicians need to educate women about their risks for cardiovascular disease and treat heart disease by using methods with known benefits.

  1. Mosca L, Collins P, Herrington DH et al. Hormone replacement therapy and cardiovascular disease: a statement for healthcare professionals from the American Heart Association. Circulation. 2001; 104:499-503.