Hormone supplements draw scrutiny

CHICAGO (AP) — A surprising new study raises questions about the effectiveness of hormone supplements containing estrogen in warding off heart trouble in older women.
The study involved only women who already had heart disease, and the study’s authors and other experts rushed to say that the findings should not be assumed to apply to healthy women. A much larger study now underway will shed more light on that question, they said.
Millions of women take estrogen supplements to replace the hormones their bodies stop making at menopause. The supplements relieve symptoms such as hot flashes and vaginal dryness and protect against thinning bones.
Previous studies found that women taking these supplements suffered up to 60 percent less heart disease.
The latest study, published in Wednesday’s Journal of the American Medical Association, involved 2,763 postmenopausal women with heart disease. All of them had suffered heart attacks or chest pain caused by blocked arteries, or had undergone bypass surgery or angioplasty.
Those who were randomly assigned to take a supplement containing estrogen and a type of hormone called a progestin suffered no fewer heart attacks over four years than the other women.
To researchers’ surprise, women taking the supplements actually suffered more heart attacks during the first year. But they had fewer heart attacks later, and the effects balanced out over four years.
The study’s lead author, Dr. Stephen B. Hulley, chairman of epidemiology and biostatistics at the University of California at San Francisco, cautioned that the findings are directly applicable only to women who already have heart disease.
He said more research is needed to determine whether the findings also hold true among women who do not yet have heart disease.
Dr. JoAnn E. Manson, an endocrinologist at Harvard-affiliated Brigham and Women’s Hospital in Boston, said if the study had been extended, it might have shown an overall long-term benefit. But she acknowledged that the findings “somewhat dampen enthusiasm” for the belief that hormone supplements protect the hearts of healthy women.
For now, Hulley said, a woman’s decision about whether to take hormone supplements should be made with her doctor, based on her individual traits, preferences and the evidence available.
Estrogen alone is no longer prescribed to most postmenopausal women because it can promote uterine cancer. Progestin offsets the cancer-causing effect. But progestin also may diminish the heart protective effect associated with estrogen alone, Manson said.
The previous studies on estrogen and the heart involved women who were taking hormones even before they were enrolled in the research. People who opt for preventive therapy tend to have healthy habits generally. That may explain most of the heart advantages attributed to estrogen, experts said.
It is too soon to say whether the risks associated with estrogen-containing supplements, including the increased risk of breast cancer, are outweighed by the benefits, experts agreed.
A far larger study of the question, a nine-year, federally funded project called the Women’s Health Initiative, will look at the pluses and minuses. It involves 160,000 women, including 27,000 taking hormone supplements, and will conclude seven years from now.
It will examine the effects of hormones on heart disease, osteoporosis, breast cancer, memory, Alzheimer’s disease and quality of life, said Manson, one of the chief researchers.