Dual-hormone therapy cuts women's heart risk


Women who take a combination of two female hormones -- the same ones commonly used to quell the symptoms of menopause -- can also lower risk factors for heart disease and stroke, according to a national study published today.

The study found that post-menopausal women taking estrogen and progestin can lower their "bad cholesterol," raise their "good cholesterol" and prevent increases in clotting factors that can trigger heart attacks and stroke.

Just as important, researchers involved in the study found that the two-drug combination did not seem to cause a thickening of the uterine lining -- a condition that often progresses to cancer. As a result, the two drugs are safer than estrogen alone, which has been shown to raise a woman's risk of endometrial, or uterine, cancer.

Dr. Trudy Bush, an epidemiologist who directed the study at the Johns Hopkins Medical Institutions, said yesterday that combined hormone therapy should be considered by all post-menopausal women and their doctors.

"I think that for a population, the benefits far outweigh the risks," said Dr. Bush, who now works primarily at the University of Maryland Medical Center.

She noted, however, that some individuals should probably avoid the drugs.

These include women with histories of liver disease and breast cancer. The drugs can complicate liver problems and possibly reignite breast cancer, although Dr. Bush said the hormones probably pose little risk for women who have survived breast cancer for more than five years.

The study involved 875 healthy women ages 45 to 64 at seven medical centers. Details appear in today's Journal of the American Medical Association.

Although heart disease is the leading cause of death of women, it has attracted relatively little public attention because it strikes women at a more advanced age than it does men. Still, it kills far more women than do all cancers combined.

The value of hormone replacement therapy has been watched closely because of its potential to ward off many problems -- not just heart disease and the unpleasant symptoms of menopause, but also osteoporosis, a bone-weakening condition.

Fragile bones are considered a major problem of aging because they greatly increase the risks of hip or spinal fractures, which in turn can cause a cascade of other problems related to immobility.

Despite its encouraging findings, the study is not likely to settle the long-standing controversy over the role of hormone replacement therapy in women's health.

Dr. Bernadine Healy, the former director of the National Institutes of Health, praised the study but said it does not answer the ultimate question of whether the drugs, aside from lowering risk factors, can actually prevent heart attacks and stroke.

Also, she said, further research is needed to determine how long women should take hormone replacement drugs.

Hormone replacement has been hotly debated by women's health advocates, some of whom have argued that estrogen loss is a natural part of aging and that drug therapy raises a woman's cancer risk.

Cindy Pearson, program director of the Washington-based Women's Health Network, said the study does not answer the long-standing concern that replacement drugs trigger breast cancer. That issue might be settled by a 15-year study, just under way, that will weigh such risks against the drugs' potential to prevent disease.

Until the question is answered, she said, the hormones should be taken by small groups of women -- including those who have "severely uncomfortable" symptoms of menopause and those at risk for serious osteoporosis.

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