New guidelines for hormone replacement therapy

By Rhonda Rowland
CNN Medical Unit

The American Heart Association is advising physicians to steer clear of prescribing hormone replacement therapy (HRT) for the sole purpose of preventing heart attack and stroke in women who already have cardiovascular disease.

"The recommendations relate only to the use of hormones for cardiac protection. It does not relate to hormone use for other issues," said Dr. Nanette Wenger, Emory University School of Medicine and co-author of the AHA Science Advisory published in the journal Circulation.

"For women who are documented to have heart disease, women who have angina, who have had a heart attack, who've had bypass surgery, who've had angioplasty, that hormone therapy not be started for the purpose of cardiac protection, and the reason for it is for the potential early risk."

The potential early risk relates to findings seen in the Heart and Estrogen Progestin Replacement Study (HERS), which followed women who already have heart disease for four years. In the first years of the study, the women taking the hormone therapy had a 52-percent greater chance of having a coronary event, a non-fatal heart attack or a death from heart disease, compared to women who were taking a placebo.

EXTRA INFORMATION Questions and answers about hormone replacement therapy and heart disease

"Together with that was the women who were receiving hormone therapy had a greater occurrence of leg clots, deep vein leg thrombosis and a sizeable increase in gall bladder disease. So we began to see adverse effects and no benefit, and this really raised concern," said Wenger.

A similar finding was seen in the 15-year-long Women's Health Initiative study, which is expected to answer the question of whether or not HRT can protect healthy women from heart disease. There was an unanticipated, but small, increase in the number of heart attacks and strokes in the women taking hormones.

"The documented risks have essentially been an odyssey of discovery and much of this is fairly recent." said Wenger.

For women with heart disease who have been taking hormones for some time, the guidelines recommend weighing the benefits, such as relief from hot flashes or prevention of osteoporosis, against risks, such as blood clots and possibly breast cancer.

For healthy women now taking hormones, the information suggests there's no need to make a change.

"I'm still telling them that the weight of the evidence, considering breast cancer, considering osteoporosis, considering coronary artery disease -- they should take estrogens" said Dr. Lawrence Phillips, an endocrinologist at Emory University.

Is there still a chance hormones could prevent heart disease in healthy women?

"Primary prevention studies have really not come out yet, so I think the jury is still out on that" said Dr. Penny Castellano, an Emory gynecologist.

Hormones still have no equal in alleviating sometimes serious menopausal symptoms.