Last time we discussed the mechanism by which the loss of estradiol (E2) raises the risk for heart disease in post-menopausal women.
The risk is great, but the news is good: it is a risk we can take charge of and, with the right choices, we can prevent it happening.
Last time we discussed the mechanism by which the loss of estradiol (E2) raises the risk for heart disease in post-menopausal women.
The risk is great, but the news is good: it is a risk we can take charge of and, with the right choices, we can prevent it happening.
Today I will elaborate on hormone replacement therapy (HRT). HRT is one way for women to alleviate menopausal symptoms and reduce the risk of heart disease.
This is a very controversial topic, and I am not writing this as a for-or-against piece. This is merely a brief explanation of the concept of HRT.
Hormone replacement therapy has been around since the late 70s. The spotlight was cast on it in 2002, when results from a huge research trial in the US (the Women's Health Initiative trial), showing a link between HRT and strokes, some cancers and heart attacks, were released to the press.
Because it was a really well-designed trial and had thousands of participants, the results carried a lot of weight.
An emergency copy of a well-respected peer-reviewed journal was released and newspapers carried the information.
The result was widespread fear and the almost immediate abandonment of the HRT across the globe. I doubt that HRT will ever recover its reputation following that trial, but in 2009 a researcher and doctor called John Stevenson, of University College London, decided to review the data that had led to the widespread panic.
Stevenson found that the data had not been managed as it should have been: it was important to interpret the data relative to the age of the women, previous family history of breast cancer, strokes and heart disease, and also to previous incidents of any illness of that nature.
It was also important to take into account how long each of the women had been taking HRT. It appeared that in the hurried release of the data, these stratifications had not happened, and when Stevenson reviewed the data with these factors in mind, the reported risk decreased to virtually nil in most cases.
The journal in which the data was published has subsequently acknowledged that the data may have reported risk higher than in fact existed, and the newspaper which first published the data in the US subsequently printed an apology (many years later – so the damage was done).
This information should not be taken to mean HRT is safe. I make no such claim, because I am in no position to do so. But given this information, what do we do?
The current guidelines suggest that you consult your medical practitioner every step of the way;, that HRT be taken for as short a period as possible, and at the lowest effective dose.
There is no doubt that it alleviates symptoms of menopause, which is what it is primarily prescribed for anyway.
Not everyone needs it, and you should follow the advice of your doctor.
Next time we will discuss cholesterol. I'll show you why cholesterol isn't as bad as it is often made out to be – but why it is important we have it checked regularly.
Janet Viljoen is a researcher in the Department of Human Kinetics and Ergonomics, Rhodes University.
This is the third in her four-part series on heart health.
