Heart benefits found for estrogen users.

New findings offer the strongest evidence yet that estrogen supplements help protect postmenopausal women from coronary artery disease. Nonetheless, some physicians remain cautious about recommending estrogen therapy because of concerns that it might increase the risk of cancer.

During the 1960s and early 1970s, physicians routinely prescribed this sex hormone to combat hot flashes, night sweats and other symptoms of menopause. But estrogen's reputation plummeted in the mid-1970s with reports that women taking the drug had higher rates of endometrial and breast cancer.

While the cancer risk remains unclear, a large-scale study of postmenopausal women now indicates that those who take estrogen cut in half their risk of fatal or nonfatal coronary disease compared with those who have never taken estrogen. The researchers, led by Meir J. Stampfer of the Harvard School of Public Health in Boston, reached this conclusion after statistically adjusting for age and other cardiovascular risk factors.

His group's findings, reported in the Sept. 12 NEW ENGLAND JOURNAL OF MEDICINE, represent the latest analysis of the ongoing Nurses' Health Study (SN: 11/2/85, p.279). During a 10-year period starting in 1976, Stampfer's team gathered data on estrogen use and heart disease by questioning 48,470 postmenopausal and initially healthy female nurses.

Although other studies have suggested a link between estrogen therapy and stroke risk, no such connection showed up in the new data. "I think the jury is still out on stroke," Stampfer says.

The study did not assess cancer risks. Today, most physicians who prescribe estrogen replacement therapy add another hormone, usually progestin, to lessen any cancer threat. Researchers still need to determine whether the addition might undermine estrogen's heart benefits, Stampfer says.

The new findings do not prove that estrogen therapy protects against heart disease, argues Lee Goldman, a cardiologist at Brigham and Women's Hospital in Boston. The results could be skewed, he says, if heart-healthy women are more likely to opt for estrogen therapy. Only a randomized clinical trial can offer definitive proof of estrogen's heart benefits, Goldman asserts in an editorial accompanying the research report.

The decision on estrogen treatement remains a tough call for women and their physicians. Both Stampfer and Goldman say they think most postmenopausal women would benefit from estrogen therapy, but they shy away from a blanket recommendation.