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Cholesterol Test Spots When HRT Raises Heart Risks

THURSDAY May 22, 2008 -- Standard cholesterol evaluations may help predict which women are at risk for heart problems while taking hormone replacement therapy, and which women are not.

Simply put, those with good cholesterol levels experience no increased risk for heart attacks while taking hormone therapy, while women with high levels do have a heightened risk, a new study suggests.

But this doesn't mean that all women whose cholesterol levels are within normal range should feel comfortable taking hormone replacement therapy (HRT) for menopausal symptoms.

"You have to look at the total health of the woman and not just the heart," said study author Dr. Paul Bray, director of hematology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. "Our study is confined to heart and coronary disease outcomes, which is important, because there was a substantial amount of bad press related to hormones and coronary outcomes, so that put women in the position of either feeling guilty for using hormones when they really had no other good therapy or denying themselves when they perhaps didn't need to."

Hormone replacement therapy can also affect the risk of cancer, blood clots, strokes and more, pointed out Bray, whose report is published in the June 1 issue of the American Journal of Cardiology.

"It's an individualized program," emphasized Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City. "It depends on the woman, and you have to weigh the risks and benefits. Clearly, you're not going to use hormones in a woman who has risk factors for heart disease."

Some studies, notably earlier results from the U.S. government-sponsored Women's Health Initiative (WHI) have shown an increased risk of heart attacks and strokes among women who use hormone therapy. HRT also carries with it an increased risk of breast cancer.

Many women abandoned HRT after the first WHI results were released in 2002.

This study aimed to see if standard biomarkers could predict which women would have heart problems while using HRT.

Researchers obtained cholesterol and C-reactive protein (CRP) levels related to 271 coronary heart disease "events" occurring in women during the first four years of the WHI, and compared them to a group of more than 700 controls.

As it turned out, the ratio of LDL ("bad") cholesterol to HDL ("good") cholesterol at the beginning of the trial did seem to predict which women were prone to problems while taking HRT.

"If the ratio was less than 2.5, then there was no increased risk of heart attacks when using hormones," Bray said. "If it was greater than 2.5, there was an increased risk. We did not find that CRP substantively helped us in this prediction." The findings were true both among women taking estrogen alone and among those taking estrogen plus progestin.

Women with high ratios of "bad" to "good" cholesterol have a higher risk of coronary heart disease anyway. Taking hormones just increased that risk, the researchers said.

The tests did not predict the risk of stroke.

"If a woman were to come in, after assessing all of her organs, if you decide her heart is one of the things you're worried about most, you would assess her blood cholesterol level, and if the ratio was greater than 2.5, I would discourage her from using HRT," Bray said. "If the ratio were less than 2.5, you could provide some reassurance that the risk of having a heart attack is not increased.

More information

Visit the National Heart, Lung, and Blood Institute for more on the Women's Health Initiative.

Posted: May 2008


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