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Dr. Sarrel discusses hormone replacement therapy's impact on a woman's heart disease risk.
Dr. Sarrel:
Well that’s very specific. The question is about the Women’s Health Initiative Study, which was a cardiac study designed by cardiologists because 50 years of research had demonstrated that estrogen treatment helped prevent heart attacks in women, and it reduced the risk of a heart attack compared to not taking estrogen by about 35 percent, which was a very important finding.
And over 50 years prior to the Women’s Health Initiative, there were about a thousand published studies of the protective effects of estrogen in the circulation and affecting the heart.
The Women’s Health Initiative first report, which came out in July of 2002, declared that the women’s hearts were not protected, and in fact there was an increase in heart events including heart attacks.
Well, the problem with that part of the study was that the hormone that was studied was not estrogen. It was a combination of estrogen with a very potent anti-estrogen, and we had shown and many others had shown that that particular hormone called medroxyprogesterone acetate or MPA or Provera, it’s all the same, wipes out the effects of the estrogen. No surprise then that you saw no beneficial effects.
The other problem with the first part of the Women’s Health Initiative was the age of the women because their average age was in their 60s, and by that time, the disease in their arteries had so far progressed that the estrogen couldn’t have its beneficial effects.
This is what I tell the cardiologists, and in fact, that happened last night at a meeting where one of the internists said exactly what you said, “Why would I ever prescribe for my patient when we know that this hormone treatment causes heart attacks?”
I said, “But you know, you are like all the rest of the family practitioners and internists; you missed the second part of the study which was just another 10,000 women who were, who showed quite clearly if they just had been given estrogen there was no increase in heart attacks.”
And in fact, if the women were under the age of 60 and given estrogen, guess what, the reduction in heart attack events was 37 percent. It was exactly what the literature had shown for the past 50 years. It confirmed the belief that if the woman is treated at the right age, at a time when her body can use the hormone, then you will see the protective effects. And that’s what I said last night.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.