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Hormone Replacement Therapy:Improves Heart Health, Overall Survival in Women

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  • Women choose to avoid hormone replacement therapy (HRT) due to the fear of cancer, stroke and other risks.
  • A retrospective analysis has shown that therapy with supplemental estrogen or similar hormones helps to lower risk of atherosclerosis (by reducing plaque formation in heart's arteries) and death.
  • Hormone replacement therapy helped to improve survival.

Hormone Replacement Therapy:Improves Heart Health, Overall Survival in Women

Women who use hormone replacement therapy to relieve menopause symptoms face a lower risk of death and show lower levels of atherosclerosis, plaque buildup in the heart's arteries, compared to women who do not use hormone therapy.

The new imaging study was conducted by investigators at Cedars-Sinai.

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Hormone replacement therapy (HRT) has always been a double-edged sword with some studies reporting lower risk of osteoporosis and improvement in heart function and others linking it to higher risk of cancer and stroke.

"Over the past 15 years, fear of cancer and other risks has led to dramatically fewer women using hormone replacement therapy," said Daniel S. Berman, MD, director of Cardiac Imaging at Cedars-Sinai and senior author on the study.

"This new study suggests that with proper screening and follow-up, therapy with supplemental estrogen or similar hormones may help improve heart health and overall survival in some women." Berman added.

Hormone replacement therapy (HRT) is usually used to relieve symptoms of the menopause. It helps to restore hormones the level of which gets decreased during menopause.

It can help relieve most of the menopausal symptoms like hot flushes, night sweats, mood swings, vaginal dryness and reduced sex drive.

Retrospective Analysis

For the study, health records of more than 4,200 women who received a coronary calcium scan at Cedars Sinai were retrospectively analyzed.

The analysis ran over a 14-year period, from 1998 to 2012.

A coronary calcium scan is a CT scan that measures the amount of calcium in the heart's arteries. A higher level of calcium is an indicator of plaque buildup, which increases the risk of heart attack and stroke.

Among the participants, 41% reported taking hormone replacement therapy at the time of their scan. Women with an average age of 64 years used HRT, while those in the non-therapy group were younger with an average age of 60 years.

The use of hormone therapy was highest between 1998-2002 and it weaned gradually from more than 60% of women in 1998 to 23% in 2012. During the average follow-up period of eight years, a little more than 6% of the women died.

Researchers accounted for factors like age, coronary calcium score and cardiovascular risk factors including diabetes, high blood pressure and high cholesterol, and found that women using hormone replacement therapy were:
  • 30% less likely to die compared to those not on hormone therapy
  • 20% more likely to have a coronary calcium score of zero, which is the lowest possible score, indicating a low risk of heart attack
  • 36% less likely to have a coronary calcium score above 399, indicating extensive atherosclerosis and a 10-fold increase in heart attack risk
"Hormone replacement therapy resulted in lower atherosclerosis and improved survival for all age groups and for all levels of coronary calcium," said Yoav Arnson, MD, a postdoctoral scientist at Cedars-Sinai and the study's lead author. "From this, we do think it is beneficial, but we need prospective randomized studies to confirm the findings and determine which groups might not benefit or might even be harmed by this therapy."

This study involved a larger population and a longer follow-up time than most other recent studies, and offers new evidence on potential cardiovascular and survival benefits. However, it does not offer definitive insights on which groups are likely to benefit most or weigh in on cancer-related or other potential risks.

Researchers caution that women who have already had a heart attack, have known heart disease or a history of blood clots are advised against taking hormone replacement therapy.

The study, Hormone Replacement Therapy Is Associated With Less Coronary Atherosclerosis and Lower Mortality, will be presented at the American College of Cardiology's 66th Annual Scientific Session.

  1. Hormone replacement therapy (HRT) - (http://www.nhs.uk/conditions/hormone-replacement-therapy/Pages/Introduction.aspx)

Source: Medindia

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