Magazine article Clinical Psychiatry News

Studies Confirm Ill Effects of Combination HRT: Heart Diseases, Breast Cancer Risks. (Hormone Replacement Therapy)

Magazine article Clinical Psychiatry News

Studies Confirm Ill Effects of Combination HRT: Heart Diseases, Breast Cancer Risks. (Hormone Replacement Therapy)

Article excerpt

For anyone who held out some hope that the Women's Health Initiative would show that combination hormone replacement therapy isn't so bad in certain subgroups of women, that hope is fading fast.

Results from two recent studies in the New England Journal of Medicine and one in the Lancet have mounted yet more evidence suggesting that combination estrogen and progestin is bad for a post-menopausal woman's heart and breasts.

In the first study, results from the final analysis of the estrogen plus progestin trial of the Women's Health Initiative (WHI) make one thing clear: estrogen plus progestin does not protect the heart. In fact, the combination may increase the risk of coronary heart disease among generally healthy postmenopausal women, especially in the first year after starting hormone replacement therapy.

"Hormone therapy should not be used to prevent or treat cardiovascular disease," Dr. Andrew Kaunitz, professor and assistant chair of the department of obstetrics and gynecology at the University of Florida Health Science Center in Jacksonville, told this newspaper. "That's a very clear message, and I don't think that point should be controversial anymore."

The study, which is an analysis of data from the WHI, found that the risk for CHD rose 81% among women who took Prempro, the conjugated estrogen/medroxyprogesterone acetate tablets manufactured by Wyeth Pharmaceuticals, compared with those who took placebo. The risk subsided over time, but at 5 years the risk for CHD still hovered around 24%. That translates to six more cases of CHD per year among every 10,000 women using estrogen plus progestin (N. Engl. J. Med. 349[6]:523-34, 2003).

Although he was not involved in this analysis, Dr. Kaunitz directs the WHI at the University of Florida. The question of whether to commence HRT "is all about the [woman's postmenopausal] symptoms," he said. …

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