HRT and Heart Attack

A new study showing that hormone replacement therapy (HRT) did not protect a group of post-menopausal women against heart attacks may cause unnecessary confusion for women taking hormones. The study, published in the October 1 Annals of Internal Medicine, was well done, but there were limitations in its design. But because most studies to date support the idea that HRT protects against heart disease, this study is an aberrant piece of a much larger puzzle.

Researchers in this study looked at medical records of 685 post-menopausal women admitted to a health care center with heart attack but no prior history of heart disease. They compared the patients to women of similar age who belonged to the center but had not had heart attacks. The researchers took into account the comparison group’s history of heart disease, as well as each woman’s education level and such heart-related health measures as cholesterol level. They found no statistically significant difference in rates of heart attack between women who had and hadn’t taken HRT.

This finding isn’t firm enough to cast doubt on the many previous studies that have found HRT to protect the heart. This study involved far fewer subjects and looked at only one event – heart attack – rather than at mortality from all heart-related events. A study that randomly selects patients to receive hormone therapy and then follows them to see how hormones affect their health would provide better grounds for broad recommendations about hormone therapy.

Several large, randomized, prospective studies of this type are already well under way. While we await results from these, decisions should be based on the numerous large studies already published that support HRT use for many women. As we discussed in our July feature article on HRT, each woman should make the decision with her doctor, based on her personal and family medical histories and risk factors for cancer, which hormones can promote, and for heart disease.

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