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Hormone
replacement therapy (HRT) should not be given to women solely
for the purpose of preventing heart attacks and strokes, according
to a new recommendation from the American Heart Association.
The new
position is based on recent scientific studies about the role
of HRT in reducing the risk of coronary heart disease in postmenopausal
women.
The heart
association said its recommendation should not lead women
to abandon hormone therapy if they are taking it for such
reasons as to reduce hot flashes during menopause or to prevent
osteoporosis.
"But
for many years, cardiologists and other health care providers
who take care of women have assumed that HRT protects the
heart," said Dr. Lori Mosca, director of preventive cardiology
at New York Presbyterian Hospital. "At this time there
is not sufficient evidence to make that claim – our purpose
is to clarify the role of hormones in heart disease prevention."
For postmenopausal
women who have had a heart attack or stroke, the guidelines
recommend that HRT not be initiated for secondary prevention.
This recommendation is based, in part, on the results of the
Heart and Estrogen Replacement Study (HERS), a large-scale
study that found no benefit of HRT among women with heart
disease.
For preventing
a first heart attack or stroke, the association recommends
reducing risk factors, such as high cholesterol and blood
pressure, through lifestyle modifications and, if needed,
with medications to improve cholesterol profiles and lower
elevated blood pressure. Pending the results of ongoing studies,
the guidelines recommend that the decision on HRT use be based
primarily on non-heart related benefits and risks.
"The
new guidelines recommend essentially taking HRT out of the
risk-benefit equation for women who have already had a heart
attack or stroke," Mosca says. "For postmenopausal
women without heart disease, we do not suggest that HRT be
taken completely out of the equation. We state that heart
disease prevention should not be used as the sole purpose
of therapy. It can weigh into the decision, it just shouldn’t
drive the decision for women without heart disease."
Source:
Medical Week staff,
week of July 29, 2001
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