Hormone Replacement Therapy (HRT) and Heart Disease

Do you still believe HRT will protect you from heart disease? Think again. The American Heart Association, in an open letter to physicians published in the journal Circulation (July 24, 2001;104:499-503), recommends that heart health should be left out of HRT decisions.

Although HRT has been shown to lower cholesterol levels, preventing heart disease is obviously a far more complex issue. The well-known Heart and Estrogen/Progestin Replacement Study (HERS), a 4-year trial, showed that conventional HRT actually raised the risk of recurrent heart attack and death during the first year, and then lowered it only slightly. Detailed review of this same study suggests that, over longer periods of time, conventional HRT may further increase the risk of heart disease because it promotes inflammation (JAMA 1998;280:605-613). Another study (Circulation 1999;100:717-722) also found that women on HRT had elevated markers for inflammation and, although cholesterol was down, fibrinogen – a protein associated with blood clots – was elevated.

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