All of the previous evidence had pointed to hormone replacement therapy dramatically reducing the incidence of heart disease for all women. Now we find out that in older women who already have heart disease, it may actually make things worse.
"We found an increased risk of heart attack and heart disease-related death in the women taking the hormones," said Dr. Deborah Grady of the University of California-San Francisco.
Millions of women take estrogen supplements to replace the hormones their bodies stop making at menopause. The supplements relieve symptoms such as hot flashes and vaginal dryness and protect against thinning bones
Dr. Grady and her colleagues tested a combination of estrogen and progestin, called "prempro," in a group of women with an average age of 66.
They found that not only did it not prevent second heart attacks, but in the first year, heart attack and death rates actually went up 52 percent. While researchers don't know why, they were concerned enough to issue this recommendation on Tuesday.
"Post-menopausal women with heart disease who have not already been taking hormone therapy should not start the therapy for the purpose of preventing new or recurrent heart attacks," Dr. Grady said.
There was another surprising finding. When women made it past the two-year mark, their risk of heart disease began to drop. The crucial question is, Will the long-term benefit outweigh that first-year risk?
"There are a number of possibile theories for early risk and late benefit, but none of them have been proven or intensively investigated. This is very new information," said Dr. Nanette Wenger of Emory University.
These findings are so surprising because the protective effects of estrogen were thought to be especially strong in women who already had heart disease.
It is hoped that further data from this study and others will help make it clear who is helped by hormone replacement therapy and who is not.
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