| Do statins make hormone replacement therapy safer? | |||||||
| New data suggests statins might mitigate risks of HRT | |||||||
By DrRichDateline: June 7, 2002 Recent randomized clinical trials have thrown cold water on the long-held notion that hormone replacement therapy in post-menopausal women can reduce the risk of coronary artery disease. Indeed, data from the Heart and Estrogen/progestin Replacement Study (HERS), as well as from the Estrogen Replacement and Atherosclerosis (ERA) trial, both showed that women with pre-existing heart disease who were given HRT had a higher risk of heart attack and death than women treated with placebo, at least during the first year of therapy. These studies also documented an increased risk of thromboembolism (blood clots) in women given HRT. Last summer, results from these trials prompted the the American Heart Association to issue new guidelines regarding the use of HRT in post-menopausal women, urging doctors to use caution in prescribing HRT. The HERS and ERA trials, and the subsequent AHA guidelines, proved to be very disheartening to both doctors and to their female patients. This week, an article published in Circulation suggests that the use of statin drugs might mitigate at least some of the negative effects of HRT in women with pre-existing heart disease. Investigators from Wake Forest University reexamined data from the HERS trial, looking specifically at women receiving HRT who also were given statin drugs. They found that women taking statins had a 21% reduction in heart attack and death caused by heart disease, and a 33% reduction in death from all causes, as compared to women not taking statins. Furthermore, women taking statins had a 55% reduction in blood clot formation. In addition, the authors point out that the use of statins in women receiving HRT seemed to significantly mitigate the major problem seen with HRT in the HERS trial, namely, the greatly increased risk of cardiac events seen during the first year of HRT. What do these results mean? The authors of the new study caution that the results of their analysis do not, in themselves, constitute proof that statins can render HRT safe in women with underlying heart disease, and do not indicate that all women taking HRT should be placed on statins. Instead, the authors suggest, their results should prompt further research to examine whether, and to what extent, statin drugs can make HRT safer. At the very least, however, women who are taking HRT - especially women who have cardiac disease - should talk to their doctors about whether they ought to be taking statins for other reasons. Many patients at risk for heart disease and who should be taking statins to reduce that risk are not receiving them. Recently revised guidelines on the treatment of cholesterol suggest that many patients who ought to be receiving statins are not getting them - women taking HRT, or who are contemplating taking HRT, now have another reason to press their doctors to follow the guidelines on the use of statin drugs.
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