Oct. 1 (Bloomberg) -- Women taking
hormone replacements didn't have a higher risk of heart attacks as long as they
avoided daily doses of both estrogen and progesterone, according to a study of a
range of treatments used by almost 700,000 women.
Women who only periodically took progesterone or who used topical medicines had
a lower chance of heart attacks, researchers led by Ellen Loekkegaard, a
gynecologist at Copenhagen's Rigshospitalet, wrote in a report in the European
Heart Journal. Those who took daily pills combining the two hormones, such as
Wyeth's Prempro, had a higher heart risk, according to the study, which examined
records of all healthy Danish women 51 years and older from 1995 to 2001.
The observational findings may allow women and their doctors to tailor the
treatment of menopause to avoid dangerous side effects. Wyeth's sales of the
Prempro and Premarin hormone replacement therapies topped $2 billion before a
2002 study known as the Women's Health Initiative found the medicines may raise
health risks. The latest study won't mean a return to the years when HRT
medicines were widely prescribed, Loekkegaard said.
``I don't think we should change the recommendations on when to use hormone
replacement therapy or not, but when and how it is used, to lower the risk,''
the gynecologist said in a Sept. 29 telephone interview.
The treatments have been available since the 1950s and were widely prescribed
until 2002, when preliminary results from the Women's Health Initiative showed
the medicines increased the risks of breast cancer, stroke and heart attacks.
The U.S. study was initiated in 1991 to assess the drugs' potential benefits.
Smallest Dose
The U.S. Food and Drug Administration recommends that when hormone therapy is
used for menopausal symptoms, it should be taken at the smallest dose and for
the shortest time possible.
Since the 2002 findings, Madison, New-Jersey based Wyeth and Pfizer Inc., the
world's biggest drugmaker, have been sued by thousands by women who said their
treatments sickened them. In July, New York-based Pfizer settled a lawsuit,
ending a trial in which 61-year-old Annie Woods said the drugmaker's Provera
medicine caused her breast cancer.
A Wyeth spokeswoman said the study findings
were based on clinical products and doses used in Denmark.
``We believe it's difficult to determine whether it's the product, the dose or
the route of administration that was responsible for the result in the study,''
said Gwen Fisher, a Wyeth spokeswoman. The study also didn't have information on
other risk factors such as weight, body fat distribution, alcohol intake,
physical activity and smoking. ``That also makes it difficult to draw any
conclusions,'' she said.
Irregular Levels
During menopause, women's natural level of estrogen becomes irregular before
declining and disappearing. As a result, they may experience hot flashes,
moodiness and depression. Doctors may prescribe estrogen supplements to combat
the symptoms and progesterone to avoid uterine cancer, which may results from
taking estrogen alone.
The Danish study found women who didn't take hormone replacement therapy were 8
percent more likely to have heart attacks than those who took estrogen regularly
and progesterone periodically, and 20 percent more than those who used estrogen
creams, gels and patches.
Administered in those manners, hormone replacement therapy is ``good, or at
least not harmful,'' Loekkegaard said.
The results echo earlier research at France's Institut National de la Sante et
de la Recherche Medicale that estrogen administered through the skin poses no
additional risk of blood clots forming in veins. That's because the hormone
bypasses the liver, which produces a protein that stimulates blood coagulation,
said Marianne Canonico, an endocrinologist said at the French institute.
``Cyclic treatment might be beneficial compared with continuous use, but the
biological reason is not clear,'' Canonico said in an interview yesterday.
Source : fschwartzkop@bloomberg.net
