By: Thomas Pickering, MD, DPhil, FRCP, Director of Integrative and Behavioral Cardiology Program
of the Cardiovascular Institute at Mount Sinai School of Medicine, New York.

While it is well established that estrogen therapy reduces the risk of heart disease in post-menopausal women, there has been considerable doubt as to whether combined estrogen and progestin therapy confers the same benefit. The combination is recommended for women who have not had a hysterectomy, because estrogen on its own may increase the risk of cancer of the uterus.

This study was part of the Nurses' Health Study, in which 59,337 nurses have been observed for up to 16 years. It was found that women who took both estrogen and progestin had about half the risk of a heart attack as women who took no hormones. Women who took estrogen alone were at similarly reduced risk. Neither estrogen alone nor the combination with progestin appeared to protect against strokes.

Doctor's comments

Estrogen tends to raise HDL cholesterol, which is one of the ways by which it may lower the risk of heart disease. Some earlier studies suggested that this benefit may be lost when it is combined with progestin, which may also raise the LDL (bad) cholesterol. It was therefore suspected that the combination of estrogen and progestin might not be good for heart disease. This study provides the most convincing evidence to date that the combination of estrogen and progestin is just as good as estrogen alone.

Where it was published