STUDY: HRT may increase risk of blood clots, and gallbladder disease

JOURNAL: Journal of the American Medical Association

AUTHORS:

ABSTRACT: Long-term hormone use doesn’t reduce heart attack risks in postmenopausal women with heart disease and may increase their chances of developing blood clots and gallbladder disease, new research suggests.

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COMMENTARY: THE FINDINGS in Wednesday’s Journal of the American Medical Association add to mounting evidence questioning doctors’ long-standing belief that hormone supplements benefit the heart by mimicking the effects of natural estrogen, which helps keep cholesterol at healthy levels.

The new research provides follow-up data on a study that was among the first to challenge that belief. The original data showed that heart patients followed for an average of about four years had more heart attacks in the first year on hormone treatment, but fewer in subsequent years. The trend suggested that benefits might occur only after long-term use.

Wyeth Pharmaceuticals, which makes the estrogen-progestin supplement Prempro used in the research, paid for the follow-up study.

The researchers found no such benefit after tracking many of the same 2,763 women for nearly three more years. During the follow-up, there were 111 heart events, including fatal and nonfatal heart attacks, in women on hormones than in those taking dummy supplements.

However, the blood clot rate was twice as high in the hormone group over the entire 6.8 years of study, with most of the risk occurring in the first few years. The rate of gallbladder disease requiring surgery was nearly 50 percent higher, bolstering evidence linking these conditions to hormone use.

The results suggest that women with heart disease should not take hormone supplements, said co-researcher Dr. Deborah Grady of the University of California at San Francisco. Grady said evidence that risks outweigh the benefits is strong enough to suggest that even women without heart disease should avoid supplement use except on a short-term basis to relieve hot flashes and other menopause symptoms.

Information on the effects of hormones in healthy postmenopausal women is expected to come in 2005 from the Women’s Health Initiative, a large national study comparing results from women taking hormones for 12 years with those on placebo pills.

If you are considering HRT talk it over with your doctor. A wise choice would be to try natural alternatives first and only resort to the stronger hormones if all else fails.

Here at the clinic the majority of women are able to go through menopause using natural HRT and take care of their bodies by doing aerobic and weight bearing exercises.