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Study Conflicts – Does Hormone Replacement Therapy HRT Cause Heart Attacks Strokes or Breast Cancer?

February 13th 2006

Study Conflicts – Does Hormone Replacement Therapy HRT Cause Heart Attacks Strokes or Breast Cancer?

Dr. Lila Nachtigall

A study in 2002 showed an increase risk of breast cancer, stroke and heart attack for women that took hormone replacement therapy (HRT).  The researchers looked at the data from the Women’s Health Initiative (WHI), which began in the early 90’s with nearly 50,000 women.  Their findings left women with a tough decision:  Should they continue with the risky HRT or should they stop?

They found that women had a 30% increased risk of heart attack when taking HRT.  Now a follow up study has reevaluated the data, and found no increased risk of heart attack when women take estrogen alone, without progestin.

The research, published in the February 13th issue of archives of Internal Medicine – one of JAMA/Archives journals, said “Estrogen therapy does not appear to reduce the risk of heart attack or coronary death in healthy postmenopausal women, although some data suggest a lower coronary heart disease risk in women aged 50 to 59 years”.


There were 10,739 participants between the age of 50 and 79 who underwent a hysterectomy.   Of these women, some were given either a conjugated equine estrogen (mix of several estrogens) or a placebo.  The researchers were planning on 8.5 year study but it was stopped in March of 2004 after only 6.8 years, because the estrogen only treatment appeared to increase the risk of stroke.

Judith Hsia, M.D., of George Washington University, Washington, D.C., and colleagues looked at the data and found the risk of coronary death was almost the same for women taking estrogen only and for those taking the placebo.  Although there was no significant reduction in heart attacks, coronary revascularization (reestablishment of blood supply to the heart) was “less frequent” among women taking the estrogen. 

The authors report “This trial may have been unable to demonstrate a significant difference in the risk of myocardial infarction or coronary death by age group because of the low event rate in young women.”


According to Dr. Lila Nachtigall, ob-gyn at the New York University Medical, “I have never seen women suffering as much from symptoms of menopause as I have now.  This paper helps us feel that overall, estrogen alone did no harm to women as far as heart disease."

Natchigall also pointed out that estrogen may have a small benefit to heart vessels.  HRT may help prevent atherosclerosis (plaque) buildup in the arteries, but not remove plaque that is already there. 

Another study, the four-year Kronos Early Estrogen Prevention Study, will try to determine whether estrogen slows hardening of the arteries in younger women.  It will include 720 women ages 42 to 48.  The researchers will also try to determine whether the estrogen skin patch is more effective than an estrogen pill.

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