HRT Prescribing: Leave Heart Out of Patient Counseling.

Advisory highlights findings that refute earlier evidence of cardioprotective effects.

The American Heart Association has shifted its stance on the cardioprotective effects of hormone replacement therapy, advising physicians that decisions about using such therapy should be based on consideration of other benefits and risks.

In a five-page advisory, the AHA said that prevention of cardiovascular disease should not be the basis for prescribing hormone replacement therapy (HRT) for postmenopausal women. The advisory reflects substantial new data refuting earlier evidence of the cardioprotective effects of estrogen and progesterone.

"It's not going to change what the ob.gyn. is prescribing right now in terms of hormone replacement therapy" said Dr. Anthony A. Luciano, an ob.gyn. and director of the Center for Fertility and Women's Health at New Britain (Conn.) General Hospital.

"Ob.gyns. in this country have never thought of prescribing estrogen [solely] for the heart. I think we all feel estrogen is a hormone that should be administered to postmenopausal women for very clear-cut reasons. We prescribe it for management of menopausal symptoms, vaginal atrophy, and prevention of osteoporosis."

Observational studies have suggested a benefit for primary prevention, but physicians generally agree that confirmation is needed from controlled trials, said Dr. Robert D. Langer, a principal investigator in the Women's Health Initiative, a long-term study that will evaluate primary prevention of cardiovascular events with HRT. Results are expected in 2006.

From 1995 until 1999, the AHA advised physicians to "consider estrogen replacement for all postmenopausal women" with cardiovascular disease.