HRT Increases Clot Risks -
Does Not Protect Heart

By Rita Rubin

Taking postmenopausal hormones for many years doesn't protect the heart, and it increases the risk of blood clots and gallbladder problems, says research out today.
The study represents the strongest evidence to date that long-term hormone replacement therapy (HRT) causes more harm than good, at least in older women with heart disease. And, the study authors say, there is no reason to think that taking hormones would benefit the hearts of younger, healthier women.

''It's gotten very simple,'' says University of California-San Francisco internist Deborah Grady, lead author of one of two reports on the study in The Journal of the American Medical Association. ''You take hormone therapy if you've got (menopause) symptoms that are bad enough that you need to take a medicine. And that's kind of it.''

Although HRT protects against osteoporosis, she says, there are effective, safer alternatives.

The findings are from a follow-up of the Heart and Estrogen/progestin Replacement Study (HERS), which randomly assigned 2,763 older postmenopausal women with heart disease to take hormones or a placebo.

Dozens of studies had observed that women who chose to take hormones were less likely to have heart attacks than their peers. But HERS found no difference between the hormone and placebo groups after four years. The results suggest that something else about women who opt for hormones, such as their higher income level, deserved credit for the previous findings.

Although there was no difference between the hormone and placebo groups at the study's end, that wasn't true for individual years. The hormone group had fewer heart attacks in years three and four, canceling out their worse record the first two years. Perhaps women who make it safely through the first couple of years of taking hormones might benefit later, a theory tested in HERS II, the follow-up study.

The follow-up study tracked 2,321 HERS participants for three more years. It found that the improvement seen in years three and four did not continue.

In addition, women who took hormones for all seven years were more likely to need gallbladder surgery or develop blood clots in their legs.

Three leading societies of obstetrician/gynecologists, as well as Wyeth, the HRT maker that funded the research, issued press releases noting that the new study does not answer how hormones affect younger, healthier postmenopausal women.

However, an interim analysis in the ongoing Women's Health Initiative, a randomized trial of more than 27,000 women, found that those taking hormones had slightly more heart attacks, strokes and blood clots after four years than those on placebo. Only 10% of that study's participants had been diagnosed with heart disease before enrolling.

In a JAMA editorial, Diana Petitti of Kaiser Permanente Southern California says: ''More evidence brings more pessimism about the preventive benefits of HRT.''

Copyright © 2002 USA TODAY, a division of Gannett Co. Inc.


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