Menopause news

Age effects of HRT on Mortality and Heart disease

9 May 2011

It is well established that HRT is the most effective treatment currently available for controlling menopausal symptoms. However, the effect of HRT on heart disease and overall health continues to be debated. Since cardiovascular disease continues to be the leading cause of death in women after the menopause, with estrogen deficiency known to lead to the increase in several risk factors for cardiovascular disease (CVD), any possible risk reducing effect of hormonal therapy must be viewed seriously.

Prior to the publication of the WHI trial in 2002, it was widely perceived that the use of HRT offered significant cardiovascular protection, and indeed, was often the reason stated for using HRT. This view changed when the WHI trail appeared to show an increased risk of CVD in women who took HRT, although later analysis in fact showed that this increase only applied to older women taking HRT. A new report from the California Teachers Study sheds more light on this hugely important subject.

71,237 postmenopausal women were followed from 1995-1996 through to 2004. Women aged less than 65 years who reported current use of HRT, (estrogen alone or estrogen combined with progestogen), had a 45% lower risk of mortality of any cause, compared to similarly aged women who reported no history of HRT use. Regarding death related to coronary heart disease (CHD), current HRT use was associated with a 16% lower risk. This risk reduction was most marked in younger women who used HRT with a 62% risk reduction in current HRT users who were aged less than 60 years, compared to never users of similar age. Women aged 75 years or older at baseline who reported current HRT use were found to be at similar risk of death as never users of a similar age.

These important results add to the increasing amount of evidence that hormone use in younger women (aged less than 60-65 years), may not only control menopausal symptoms, but also have a beneficial effect in reducing the risk of CHD and all cause related death. While HRT may continue to be required in older women for the control of persistent troublesome menopausal symptoms, it is unlikely that cardiovascular benefit will be provided at this later stage.
No doubt the debate around cardiovascular benefits of HRT will continue for some time yet, and the results of further studies are eagerly awaited, but women under the age of 60-65 should be reassured that for the majority, HRT provides more benefits than risks, and that the benefits apply not only to symptom control.

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