HRT and heart disease. And the beat goes on….

Posted by Liz on Dec 4, 2009 in heart disease, HRT | 0 comments

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Hormone replacement therapy can help prevent heart disease, right?

Think again. Research has shown that use of HRT increases the risk for stroke, blood clots and heart disease. Although increased risk starts to decline within three years of stopping hormone therapy, women are still cautioned to continue rigorous prevention efforts and to see their physicians for any recommended testing.

So, are you asking yourselves why I’m writing about this if doctors know already about the link between HRT and heart disease? Well it appears that in the early 200s, and despite a marked decline in the use of HRT among women following confirmation of the risk, as many as 8% of women with existing heart disease and 14% with two or more identifiable risk factors were still prescribed hormones by their doctors. Writing in the American Journal of Public Health, investigators of a newly-published analysis said that although the reasons are unclear, women continued to receive HRT for heart risks,  even though it “was never proven for this indication and ultimately found to be ineffective.”

To add insult to injury, the International Menopause Society, in concert with the European Society of Cardiology, has just issued a statement staying that hormone therapy, in limited doses, does not increase the risk of heart disease and may even decrease risk in younger women.What’s more, they are now saying that in some cases, HRT may even lower blood pressure. Conversely, they recommended that HRT should not be used in women with a history of heart attack, stroke or pulmonary embolism (blockage of one or more lung arteries).

Are you confused yet?

Some experts have questioned the results of the Women’s Health Initiative studies, which were the first to raise the flag about the dangers of HRT. Some argue that the studies looked at women who were older, i.e. 50 to 79 and not menopausal or perimenopausal. However, others have determined that both the timing (i.e. when HRT is started) and length of time on HRT can affect disease risks, as can type of hormone used.

In some respects, these confusing recommendations echo the recent controversy over mammography, in which medical experts have taken sides, some agreeing the screening is overrated and even dangerous, and others, saying that even the small numbers of lives saved make mammography worthwhile in younger women. That, however, is a post for another time.

Meanwhile, what should you do when it comes to HRT and heart disease risk?

As always, I urge women to err on the side of caution and do their due diligence: make an appointment with an informed health provider and discuss the risks and the benefits. There’s no way to make an informed decision without all the facts and information about how they apply specifically to you, your family and personal medical history and your unique set of needs and symptoms. At the same time, the evidence is pretty darn strong that HRT does not protect your heart and may  in fact, exacerbate other risk factors for developing a heart attack or stroke.

Is it worth it? Only you and your practitioner can decide.