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Heart findings support hormonal therapy.

A woman's chance of developing heart disease rises after "the change of life"-- perhaps because the ovaries produce much less of the sex hormone estrogen. It is well-known that estrogen-replacement therapy lowers a woman's risk of getting heart disease. Yet, studies also reveal a dark side of estrogen therapy: It boosts the chances of developing a type of uterine cancer.

To weaken that risk, some doctors advise postmenopausal women to combine estrogen with progestin, a progesterone-like drug that blocks the proliferation of cells in the uterus. Trouble is, some evidence indicates the addition of progestin cancels estrogen's heart benefits.

A controversial study now offers some heartening news: Researcher Aaron R. Folsom says that postmenopausal women taking estrogen plus progestin may reap even greater cardiovascular benefits than women taking estrogen by itself. Yet, Trudy L. Bush, an epidemiologist at the Johns Hopkins University in Baltimore, warns against jumping to such a conclusion: "I think it's premature to say that estrogen plus progestin is better than estrogen alone."

Folsom, who is at the University of Minnesota School of Public Health in Minneapolis, and his colleagues conducted an observational study of postmenopausal women. The researchers noted that 853 women were using estrogen; 173 were taking estrogen and progestin; and 3,932 were not using any hormones.

In the April 15 NEW ENGLAND JOURNAL OF MEDICINE, the team reports that post-menopausal women following either of the hormone-replacement regimens show a better cardiovascular profile than those taking no such medication. Women who took estrogen alone or estrogen plus progestin had higher blood concentrations of high-density lipoproteins (HDL), molecules that help remove cholesterol from the body and play a role in preventing heart disease. Hormone users also had lower blood concentrations of low-density lipoproteins, which contribute to the fatty buildup in artery walls.

At the same time, the researchers suggest that women using estrogen together with progestin gained a slight cardiovascular edge over the estrogen-only group. For example, women taking both hormones had lower blood concentrations of a clotting factor called Factor VII. Less clotting factor in the bloodstream may help reduce the risk of a heart attack, Folsom says. In addition, women on the combined regimen had lower blood concentrations of triglycerides, a fat that can boost the risk of heart disease.

The study design contains some built-in flaws, Folsom notes. For example, doctors may be more likely to prescribe hormone therapy to healthy women. Thus the study results may in part be due to an unforeseen selection bias, he says.

Nonetheless, endocrinologist Kathryn A. Martin, at the Massachusetts General Hospital in Boston, is reassured by the finding that the two drugs taken together seem to protect against heart disease. "I think we're on the right track by adding progestin," she says. Researchers still need to conduct a randomized trial that compares both hormone-replacement regimens, she adds..
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Title Annotation:postmenopausal women and estrogen-replacement therapy
Author:Fackelmann, Kathy A.
Publication:Science News
Date:Apr 17, 1993
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