Friday, April 04, 2008
Women's Health
Hormone replacement therapy use among women in their 50s slightly increases their risk of breast cancer and stroke but does not increase their risk for heart attack, according to a new Women's Health Initiative analysis published in the April 4 issue of the Journal of the American Medical Association, the New York Times reports (Kolata, New York Times, 4/4). NIH researchers in July 2002 ended the agency-funded WHI study on combination HRT three years early because they determined that the treatment might increase the risk for heart disease, invasive breast cancer and other health problems (Kaiser Daily Women's Health Policy Report, 4/13/06). WHI enrolled 27,347 women ages 50 to 79 in two different studies that randomly assigned women to take HRT or a placebo. One of the studies involved women taking Wyeth's Prempro, a combination of estrogen and progestin, and the other involved women who had hysterectomies who took estrogen-only therapy (New York Times, 4/4). According to the Wall Street Journal, women who used Prempro had a 24% higher risk of having a heart attack, but HRT users ages 50 to 59 had a 30% lower risk of dying of any cause during the five- to seven-year study period, compared with women who took a placebo. Women who had started Prempro use 20 years or more after they began menopause had a 71% higher heart attack risk, women who started 10 to 19 years after menopause had a 22% higher risk and women who started the therapy within 10 years of menopause had a 11% lower risk of heart problems. Estrogen-only HRT users between ages 70 and 79 had a 11% higher risk of heart attack, compared with women who took a placebo, while women under age 60 had a 37% lower risk. Only 3,425 of the women enrolled in the WHI studies were under age 55, and because there were so few women who recently went through menopause, data for the youngest groups in both the Prempro and estrogen-only studies were not statistically significant, according to the Journal (Parker-Pope, Wall Street Journal, 4/4). Breast cancer and stroke risk were not linked to age, USA Today reports (Rubin, USA Today, 4/4).
Reaction
The new analysis supports giving women HRT for only a few years to relieve menopausal symptoms, such as hot flashes and night sweats, the Boston Globe reports (Smith, Boston Globe, 4/4). Jacques Rossouw, an NIH official who designed the WHI studies, said the analysis "represents the best data we have on the important question of whether there are some groups of women for whom hormone therapy remains a reasonable option." Rossouw added that the analysis "goes some way toward settling the issue for an important group of women and their physicians" (Wall Street Journal, 4/4). Rita Redberg, director of the women's cardiovascular services department at the University of California-San Francisco, said the analysis' findings are "reassuring," adding, "The bottom line is, with regards to a short-term treatment, it's helpful." Bette Caan, a senior scientist at Kaiser Permanente's division of research and principal investigator of the Oakland Women's Health Initiative clinical center, said women in their 50s who take hormones do not "need to feel guilty that they are going to increase their risk" for heart attack (Allday, San Francisco Chronicle, 4/4).
PBS' "NewsHour With Jim Lehrer" on Tuesday reported on the study. The segment includes a discussion with Susan Dentzer, a health correspondent for "NewsHour With Jim Lehrer," about the implications of the study ("NewsHour with Jim Lehrer," PBS, 4/3). Audio, video and a transcript of the segment will be available online Wednesday.
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