U. study of hormone therapy to explore benefits to heart

Women who start hormone replacement therapy close to menopause may enjoy heart-protective benefits, despite broad-brush findings of a well-publicized 2002 study that labeled all hormone replacement therapy "bad."

A just-published study that breaks findings down by age and how close to menopause therapy starts casts those findings into doubt.

The University of Utah is one of eight centers nationwide now conducting a randomized, double-blind clinical trial of estrogen therapy for women who have just undergone natural menopause.

For now, those researchers are recommending use of hormone replacement therapy, called HRT, only to cope with unpleasant symptoms of menopause such as hot flashes. But they say recent studies, published in the Archives of Internal Medicine and the Journal of Women's Health, represent a "startling discrepancy" with the findings that damned HRT. The more recent research involved a younger group of women who used HRT around the time of menopause and it found what appears to be heart-protective benefits, apparently dependent on long-term use starting very soon after menopause.

The result is the launch of the Kronos Early Estrogen Prevention Study (KEEPS), which besides the U. includes Harvard, Yale, the Mayo Clinic and others. Each of the eight centers will enroll 90 women ages 42 to 58 for the four-year study, which will look specifically at hardening of the arteries.

In 2002, the National Institutes of Health halted its Women's Health Initiative estrogen plus progestin trial because of perceived harm. Most of those participants were in their 60s and 70s. Many of the women had started HRT long after menopause. But those researchers didn't differentiate.

Most data before that suggested that HRT was associated with a high degree of protection against coronary heart disease, mortality and osteoporotic fractures, as well as a small increase in breast cancer risk. That risk was found with combination therapy, not estrogen alone.

"Rather than saying a late start (of HRT years after menopause) is bad, they said categorically it's bad and you should stop as soon as you can. We think it was an incorrect conclusion," said Dr. Eliot Brinton, an associate professor at the U. and director of the metabolism section of Cardiovascular Genetics there. He will lead the U. trial.

In the more recent study, women ages 50 to 59 "did show signs of reduced risk of heart disease," said Dr. JoAnn Manson, chief of the Division of Preventive Medicine at Brighams and Women's Hospital and co-author of the recent reports.