HRT may prevent heart symptoms in younger women

BOSTON (Reuters) - Younger women who start taking estrogen as soon as they enter menopause may be protected from heart disease, researchers said on Wednesday.

They found that women aged 50 to 59 who took estrogen were 30 percent to 40 percent less likely than women taking placebos to have large amounts of calcified plaque in their arteries -- a widely accepted predictor of heart attack risk.

When women took their estrogen religiously, the risk was 60 percent lower, they reported in the New England Journal of Medicine.

Dr. JoAnn Manson of Harvard Medical School's Brigham and Women's Hospital, who led the study, said the results should be reassuring to women in their 50s who have been taking estrogen for their menopausal symptoms.

But, she stressed, hormone replacement therapy, or HRT, is not completely safe and women should not take it unless they have a good reason to.

"Hormone therapy should not be used for the express purpose of preventing cardiovascular disease due to other known risks, and it should be limited to treatment of menopausal symptoms at the lowest dose for the shortest duration necessary," Manson said in a telephone interview.

"So I do not believe it should be started in all women for the purpose of protecting their hearts."

Manson led the original Women's Health Initiative study, which found in 2002 that hormone replacement therapy raised the risk of blood clots, breast cancer and heart attacks.

Many women stopped taking HRT, although researchers at the time noted that many women in their study were well past menopause, with an average age of 63.

"There are still many women out there with moderate to severe symptoms who are not seeking treatment because they are concerned that estrogen could increase the risk of heart disease and other health problems," Manson said in a telephone interview.

REASSURING EVIDENCE

Manson led a new analysis of the original study. The new finding, based on 1,064 women, "does provide some additional reassurance for women who have been denying themselves relief," she said.

Robert Rebar, executive director of the American Society for Reproductive Medicine, said, "We are clearly learning that the benefits of estrogen in young, healthy, symptomatic, postmenopausal women outweigh the risks."

A medical consultant for Wyeth Pharmaceuticals, which makes the hormone therapy products used in the study, told reporters in a telephone briefing that many women should be put on estrogen when they hit menopause and stay on it indefinitely.

Howard Hodis, a heart specialist at the University of Southern California, said there is "absolutely no evidence that if you start a women (on estrogen) at menopause at, say age 51, and continue that until she's 80, that her risk goes up as she gets older."

The only important statistic, he said, is that continued estrogen therapy helps women live longer.

"If you have a drug that reduces overall mortality, why wouldn't we use it? It's the best product for reducing bone loss," Hodis said.

Michelle Warren of the Columbia University College of Physicians and Surgeons, another Wyeth consultant, said it is impossible to know when to stop taking the hormones.

"There are downsides to stopping estrogen," she said, suggesting that the new study shows that heart disease may accelerate if women stop. Other studies show bone loss becomes a problem as well.

"If you've been on the hormone since the time of menopause, I'm not worried anymore," Warren said.