For many years, hormone replacement therapy (HRT) was used to alleviate uncomfortable symptoms, such as hot flashes and night sweats, associated with menopause. With the controversy surrounding the connection between hormone replacement therapy and increased incidence of heart disease, many women – and healthcare providers – have shied away from giving hormones to post-menopausal women to treat their symptoms. A new study published in the June 2008 issue of the American Journal of Cardiology suggests that a simple cholesterol test may be able to predict women who are at higher risk of developing coronary heart disease while taking hormone replacement therapy.
This study is part of a series of studies known as the Women’s Health Initiative, which examines the health conditions, such as heart disease and osteoporosis, in post-menopausal women. Approximately 978 post-menopausal women without a history of heart disease participated in this study. These women took estrogen, with or without progesterone, and were assessed for levels of C-reactive protein and the ratio of LDL (“bad”) cholesterol to HDL (“good”) cholesterol (LDL/HDL cholesterol ratio). C-reactive protein and LDL/HDL ratio are two markers that are used to predict heart disease.
High Cholesterol May Increase Your Risk Of Heart Disease If On HRT
The investigators found that women with a LDL/HDL ratio less than 2.5 did not have an increased risk of developing heart disease when taking hormones. However, they did find that LDL/HDL ratios greater than 2.5 raised the risk of heart disease when taking hormone replacement therapy. This translates to women with higher levels of LDL cholesterol and lower levels of HDL cholesterol are at a higher risk of heart disease when taking hormone therapy – regardless of whether it is estrogen alone or combined with progesterone. This relationship was not observed in C-reactive protein levels.While hormone replacement therapy is the most effective in terms of relieving the hot flashes and night sweats associated with menopause, it can produce heart-related problems – especially in those women who are already at high risk for heart disease. Cholesterol testing may be beneficial in identifying who may be more at risk of coronary heart disease while taking hormones. However, before you decide to take hormone replacement therapy, heart disease risk is not the only thing you need to consider. Overall health, including risk of stroke, breast cancer, and other factors also need to be considered, since hormone replacement therapy has also been shown to increase the risk of developing these conditions.
Sources:
Bray BF, Larson JC, LaCroix AZ, et al. Usefulness of baseline lipids and C-reactive protein in womens receiving menopausal hormone therapy as predictors of treatment-related coronary events. Am J Cardiol 2008;101:1599 –1605.
