Posted on: Monday, July 23, 2001

Cautions issued on therapy for menopause

By Beverly Creamer
Advertiser Staff Writer

Doctors are being advised not to prescribe hormone replacement therapy for menopausal women who have had heart attacks or coronary bypass surgery.

Guidelines published this morning in "Circulation: Journal of the American Heart Association" advise physicians to choose other therapies to reduce the risk of a second attack or a stroke.

The recommendation is based on recent studies that found no benefit from hormone replacement therapy in women with heart disease, plus an increased risk of heart attack during the first year of taking the supplements.

"The theory on this is, during the first year, there's an increased chance of blood clotting on HRT, which could affect vessels that are already clogged," said Dr. Helen Petrovich, co-principal Hawai'i investigator of the Women's Health Initiative and an associate professor of medicine at the University of Hawai'i John A. Burns School of Medicine.

The Women's Health Initiative is a 10-year federally financed study of 100,000 women in 45 cities, including Honolulu, which aims to better understand how replacement hormones and a low-fat diet affect heart disease, breast cancer and osteoporosis in healthy women.

Petrovich said if a woman has had a heart attack and already has been on hormone therapy for several years, "they don't suggest taking her off (hormones)."

In those circumstances, doctors may consider also prescribing an anti-coagulant such as aspirin.

The new guidelines recommend reducing risk factors with lifestyle change or medications that lower blood pressure or improve cholesterol levels.

These new recommendations fly in the face of studies holding that estrogen protects against heart disease. It makes the choice to use hormone replacement more difficult for the 50 million U.S. women over the age of 50.

"For many years, cardiologists and other health care providers who take care of women have assumed that HRT protects the heart," said Dr. Lori Mosca, lead author of the Heart Association's Science Advisory "Hormone Replacement Therapy and Cardiovascular Disease" and director of preventive cardiology at New York Presbyterian Hospital.

"At this time, there is not sufficient evidence to make that claim. Our purpose is to clarify the role of hormones in heart disease prevention."