Hormone therapy could accentuate certain pre-existing heart disease risk factors and a cardiac health evaluation should become the norm when considering estrogen replacement, new research suggests.
In women without existing atherosclerosis, hormone therapy use included some positive effects on lipids but also some negative effects related to heart health, says MaryFran Sowers, lead researcher and professor of epidemiology at the School of Public Health.
The study came about, Sowers says, in trying to explain what’s behind the so-called timing hypothesis. This hypothesis suggests that if a woman implements a hormone therapy program within six years of her final menstrual period, this narrow window is enough to deter heart disease from developing with the onset of menopause. But the findings suggest that explanation isn’t quite so simple, Sowers says.
Even within the six-year window, there were negative aspects related to heart disease. While the positive outcomes on HDL and LDL cholesterol levels were observed, Sowers says, researchers also saw negative outcomes in terms of the inflammation process, which can be related to heart disease.
Sowers says the research shows it’s critical for women considering hormone therapy to discuss their heart health with their doctors.
“If the woman walks into the doctor’s office with a certain degree of (heart disease) burden already, then she and her health care provider may decide that hormone therapy adds too much to the burden,” Sowers says. “If she doesn’t have that burden, they may decide that hormone therapy is an acceptable burden.
“The woman should say to her health care provider, ‘What kind of information do we need to gather in order to make an informed decision about whether or not hormone therapy should be pursued? I understand there could be some heart disease risk, but that the risk may be based upon where I am now, and can you tell me where that is?’ “
Heart disease risk can be measured through lipid panels, which are standard, but also by measuring inflammation markers, Sowers says. Tests for these markers exist but the measurement isn’t standard when a woman is considering hormone therapy, she adds.
Hormone therapy has been controversial for years, and there was a time when there was an almost knee-jerk reaction against it, Sowers says. This backlash occurred after the findings from the Women’s Health Initiative study showed that some women on estrogen therapy had increased heart disease risk. The six-year timing hypothesis was an attempt to explain the findings in the WHI study, Sowers says.
