Monday, October 22, 2012

DOES HRT PROTECT THE HEART?

Does oestrogen protect the heart? Is that why coronary artery disease is premenopausal women is uncommon, but the curve catches up once the female reaches menopause?
Doctors have been struggling with this issue for a long time, because the evidence obtain from the earlier studies were conflicting. Chief of this was the Women Health Initiative, published in 2002 which showed that hormone replacement therapy ( HRT ), given to post-menopausal females may not protect the heart and may lead to more cancers of breast and uterus. As a result of the 2002 WHI paper, many of us had stopped giving post-menopausal females HRT, unless strongly indicated by their menopausal symptoms.
Well, all this is about to change. Dr Louise Schierbeck and colleagues from the Hvidore Hospital, Denmark, had just published an important on this subject, in the Oct 9th online edition of the British Medical Journal. They studied the effects of giving HRT to 1006 females aged 45-68 yrs ( mean 50 years ) for 10 years ( discontinued after 2002 but followed up for 16 years ). They found that there was a 52% reduction in death, MI and hospital admission for heart failure. There was no increase in cancers. These patients were all part of the Danish Osteoporosis group, half receiving HRT and half were not on HRT.
 

 Results after 10 years of intervention in Danish Osteoporosis Prevention Study

End point HRT group (n=502), n Control group (n=504), n Hazard ratio 95% CI p
Primarya 16 33 0.48 0.26- 0.87 0.015
Mortality 15 26 0.57 0.30-1.08 0.084
Cancer 36 39 0.92 0.58-1.45 0.71
Breast cancer 10 17 0.58 0.27-1.27 0.17
DVT 2 1 2.01 0.18- 22.16 b
Stroke 11 14 0.77 0.35-1.70 0.70
  
The difference between this Danish study and the WHI is the timing of the HRT. Looks like that is crucial. In the WHI, HRT was giving at average age 63Yrs, but in this Danish Study, HRT was giving at average age 50yrs. This Danish study has the longest FU ( at 16 yrs ) although the number enrolled was relatively small, at 1006 patients. 
Looks like we are back to supporting HRT as primary prevention of CAD for females, which in a way makes sense as we see few AMIs / CADs in pre-menopausal females. As I always tell the young 35year old females who sees me for all kinds of non-cardiac chest pains, God has protected you by giving you a healthy dose of natural oestrogen / progesterone, in the right amount at the right time. Enjoy it.












































3 comments:

msforty5 said...

I still don't trust HRT, cuz I'm one of those who has been exposed to the combi of un-natural estrogen, progesterone whatever & had bigC thrown right in my face when I was pre menopausal. An aunt (unrelated) took HRT for 4yrs plus & diagnosed with breast ca, while late sis in law told me not to touch HRT cuz she took it after being told of BENEFITS when she was surgically menopause at 45, after 8yrs she had cancer of the rectum then 2yrs down the road lung ca while another late aunt (maternal) had womb ca after being on some form of hormonals contraceptive for more than 5yrs. Perhaps its better to die of heart disease rather than bigC! We Asians are not of the same genetic profile maybe our body can't take HRT or synthetic hormones. If 8yrs ago I knew PREMARIN stands for pregnant mares horse urine, I would not even touch it, you have no idea the hormonal tantrums and havoc it caused :(

mark mckenna said...

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Lisinopril said...

these are the reasons ive heard:

1. oestrogen protects womens hearts so they start having heart attacks when they stop producing as much oestrogen in mid-50s onwards - whereas men start having heart attacks in their 40s.
2. women get more support socially.
3. men live less healthy lifestyles - exercising less, eating worse, drinking more etc.
4. men are more likely to be killed due to violent behaviour, and in wars etc.

are there any other explanations for why women live longer?

By:Lisinopril