Early HRT Protects a Woman's Heart
TUESDAY, Nov. 6 -- The hormone plot thickens.
New research presented Tuesday at the American Heart Association (AHA) annual meeting finds that hormones at any age can pose heart issues -- good and bad -- for women.
One study reaffirmed that hormone replacement therapy (HRT) started earlier in a woman's life has a protective effect when it comes to coronary heart disease.
"The good news about [the HRT] study is that it supports previous research that maybe it's not a question of hormone therapy itself but the timing," said Dr. Nieca Goldberg, an AHA spokeswoman and medical director of the Women's Heart Program at New York University School of Medicine.
"Women need to be assessed for hormone therapy by their menopausal symptom status and age and whether or not they have heart disease," Goldberg said. "The AHA recommendations are not changed based on this study. Hormone therapy should not be used for prevention or treatment of cardiovascular disease, but it should be used in appropriate women who are having menopausal symptoms."
A second study presented at the meeting in Orlando, Fla., found that women taking oral contraceptives run the risk of developing more arterial plaque in the carotid and femoral arteries.
Ironically, this particular finding may provide a window of opportunity for more heart protection efforts for women, experts said.
"I see this as an opportunity to assess women's cardiovascular risk at an earlier age," Goldberg stated. "Women who are on oral contraceptives or thinking about them should go into their doctor and check out their risk factors. It's an optimal opportunity to get women into the health-care system to evaluate their cardiovascular risk. Start thinking heart. It's part of your body."
Heart disease remains the number-one killer of women, although awareness of this fact seems to lag behind concern about breast cancer. More research, however, is focusing on women and heart disease and on gender gaps in treatment of the disease.
The HRT findings come from the WISE (Women's Ischemia Syndrome Evaluation) study, which included women with some coronary artery disease. While women who started HRT before the age of 45 saw a protective effect, those who started replacement therapy later saw more disease. The study was sponsored by the U.S. National Heart, Lung, and Blood Institute (NHLBI).
The findings were not consistent with those of the Women's Health Initiative, leading NHLBI cardiologist and study co-author Dr. George Sopko to say, "I'm somewhat surprised by that. In our cohort, many -- if not most -- of these women had uninterrupted hormonal status. There was not a gap between the decline of reproductive hormone levels and the start of replacement therapy, and maybe that is one of the key elements."
Oral contraceptives are one of the most frequently used drugs in the world with 100 million women taking them, yet there is not nearly as much heart research into contraceptives as there is into HRT.
This Belgian study found a 20 percent to 30 percent increased prevalence of plaque in the carotid and femoral arteries for every 10 years of exposure to oral contraceptives.
Does this mean women should be wary of taking the pill?
"That is a question for a philosopher, not a physician," said study lead author Dr. Ernst Rietzschel, of Ghent University's department of cardiovascular disease and public health. "We don't prescribe oral contraceptives so women will live longer. Women take them, because they want contraceptives, and contraceptives have been an enormous force for a lot of women to fulfill their rightful role in society. I believe the options should stay open, maybe not for very long time frames."
Two additional studies presented Tuesday found gender differences in how women "present" with heart disease and how they respond to treatment.
The first study found that two risk factors -- smoking and family history -- are associated with presenting with STEMI (ST-segment-elevated myocardial infarction) at an earlier age for women. In general, women tend to manifest coronary artery disease about a decade later than men.
"The most striking relationship we found was that with cigarette smoking. So, women who did not smoke had an average age of 71, whereas the average age of presentation in women who do smoke or had a history of smoking was 62," said study lead author Dr. William Herzog, of Johns Hopkins Medical Institutions, in Baltimore.
(A study presented Sunday at the AHA meeting by the same group of researchers found that almost all of the risk associated with earlier age of presentation was due to current smoking, rather than a history of smoking.)
These findings essentially erase the protective heart gender gap for women who smoke. "If you compare the age of nonsmoking men to the age of smoking women, it is not significantly different," Herzog said. "It suggests that women are more susceptible to the risks associated with cigarette smoking."
A final study presented Tuesday found that women are at higher risk for adverse events following implantation of an implantable cardioverter defibrillator (ICD), which monitors and "paces" the heartbeat.
"These results should not preclude women from receiving ICDs; however, the reasons should be investigated and, where possible, limited or at least measures taken to reduce the higher risk," said Dr. Pam Peterson, assistant professor of medicine at Denver Health Medical Center and the University of Colorado at Denver and Health Sciences Center.
Visit the AHA's Go Red for Women campaign for more on women and heart disease.
Posted: November 2007
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