AHA: Women, HRT, and Heart Disease

The American Heart Association (AHA) has some new recommendations about hormone replacement therapy and heart disease. On the Early Show medical correspondent Dr. Emily Senay explained.

There is no question that hormone replacement therapy works well for many women in alleviating some symptoms of menopause and helping them to avoid osteoporosis. Now in question is the role of hormone replacement therapy in preventing heart disease.

The AHA is formally recommending that women with a history of cardiovascular disease not take hormone replacement therapy if the only goal is to prevent further cardiovascular problems.

It seems like we hear something different about the pros and cons of hormone replacement therapy every time the subject comes up . . . What's the latest advice from the heart association?

Hormone replacement therapy works well for a lot of women when it comes to alleviating some of the symptoms of menopause and avoiding osteoporosis. But its role in preventing heart disease is now in question. The heart association is making a formal recommendation that women who have a history of cardiovascular disease--heart attacks and strokes--not take hormone replacement if the only goal is to prevent further cardiovascular problems. The heart association is responding to the confusion felt by many women and their doctors with these new guidelines.

Haven't we heard in the past that hormones reduce the risk of heart disease?

Yes, we have heard for years that hormones help the heart, so this newest recommendation seems like a major reversal. But the assumption that HRT is good for the heart was not conclusive, and newer studies have shown that HRT may actually increase the risk of heart disease early on by causing blood clots. In fact, surprising data coming out little by little from ongoing studies have called into question many of the assumptions made about HRT and the heart. These newer studies are believed by many researchers, though not all, to provide more reliable information because of the way they are designed.

So which studies are we to believe?

At this time each woman along with her doctor will have to weigh her own situation given the best information at this time. The data are indeed ambiguous when it comes to hormones and the heart but the good news is that are several large ongoing studies that will shed much light on these issues within the next few years. It may be very helpful to many women and their doctors to know that the heart association says firmly that at this time there is not enough evidence to support the notion that hormones protect the heart. Again, however, there are those who do not agree with the heart association's position.

What other guidance does the heart association give?

First, HRT should not be started in women with a history of heart disease if the only goal is to prevent further heart problemor strokes. Second, women with heart disease who are already on HRT should take into consideration things other than heart disease in any decision to continue or stop hormones. That would mean for example if a woman had a strong family history of osteoporosis she may want to continue therapy. And finally, if a woman has a heart attack while on HRT then hormones should be stopped until after the acute period has passed. And again, restarting it should not be done if the goal is to stop further problems.

But what about the many women who do not have heart disease. Should they be taking hormone therapy?

First, the heart association says there is not enough data to support the initiation of HRT if the sole purpose is to prevent heart disease in healthy women. Second, firm clinical recommendations about this issue await ongoing clinical trials. Third, a decision about starting or stopping therapy should be made based on other benefits of HRT such as its proven benefit or hot flashes or for osteoporosis. Finally, prevention of heart disease should start with the basics--quitting smoking, good diet, exercise, and if necessary other medications that help control cholesterol.

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