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.
Although there is mounting evidence that estrogens can lower the chances of getting heart disease, there is still uncertainty as to whether women should take them routinely when they reach the menopause, and if so, for how long. An important new study gets a bit nearer the answer. It is a report from the Nurses’ Health Study, which has been following the course of more than 120,000 nurses since 1976. The analysis was a case-control study, in which cases (3,637 women who had died during the period of observation) were compared with healthy control women who were still alive. Every two years throughout the study, participants were asked a number of questions, which included their use of hormones and an evaluation of cardiovascular risk factors.
Women who used hormones showed a 37% reduction in mortality, mainly because of a reduction in deaths from coronary heart disease (47%). Women who took progestins as well as estrogens showed a slightly greater reduction than women who took estrogens alone. However, the lower mortality just about disappeared in women who had been taking estrogens for more than ten years. The lower heart disease mortality was still seen, but this was offset by a 43% increase in deaths from breast cancer. The reduction in heart disease mortality did not occur in women who had no risk factors for heart disease (such as high blood pressure).
Doctor’s comments
This is one of the largest and most compelling studies of the long term use of estrogens in postmenopausal women, and is in agreement with earlier studies which showed that hormone use could halve the risk of heart disease. One important implication is that it may be inadvisable to take estrogens for more than ten years because of the increased risk of breast cancer.
Where it was published
Grodstein F and colleagues. Post menopausal hormone therapy and mortality. The New England Journal of Medicine.1997;336:1769-75.
