Less Heart Disease, More Stroke Risk: What's a Girl to Do?

2001 JAN 11 - (NewsRx.com) -- by Maryclaire Lindgren, staff medical writer -- Postmenopausal hormone therapy decreases the risk of coronary events in women, even at the lower 0.3 mg dose of oral conjugated estrogen, however, estrogen doses at the standard 0.625 mg dose or higher increase a woman's stroke risk.

So, given this information, what should a woman do? Francine Grodstein, ScD, of the Channing Laboratory, Brigham and Women's Hospital, Massachusetts, and associates recently released data relating to issues involved in the decision to use or not use hormone therapy.

The results of their investigation of type, dose, and duration of the use of postmenopausal hormone therapy were published m the December 19, 2000 issue of the journal Annals of Internal Medicine. Their study population included 70,533 postmenopausal nurses enrolled in the Nurses' Health Study.

"The Nurses' Health Study investigation of primary prevention indicates that hormone therapy may be associated with coronary benefits and that low doses of estrogen as well as estrogen combined with progestin may be equally effective in providing these benefits. However, the risk of stroke appears to be increased with hormone use. In addition, hormone therapy is related to increased risk for breast cancer. Clearly, alternatives should be considered that promote healthy aging and pose no risks, such as physical activity, a healthy diet, and smoking cessation," Grodstein et al. reported.

The Nurses' Health Study, begun in 1976, provided the researchers with information through June 1996. Primary nonfatal myocardial infarction, or heart attack (953 cases); fatal coronary disease (305 cases), and both fatal (119 cases) and nonfatal stroke (767 cases) were identified. Close to half of the study population never used hormones (44.3%), the researchers noted, while 32.8% were current users and 22.9% were past hormone users ("A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease," Annals Intern Med, December 19, 2000;133(12):933-941).

Overall, Grodstein et al. found that hormone therapy reduced the risk of major coronary events compared to no therapy. This held true for short-term use, they said, noting that prior to this study, there was ...