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Hormone replacement therapy begun at menopause has benefits and is safe

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The use of hormone replacement therapy (HRT) dropped after significantly after 2002 when the large government study, the Women's Health Initiative, reported it increased the risk of heart attack and stroke in older women. However, a large multi-center study reported that HRT begun soon after the menopause appeared to be safe and lowered the risk of heart disease; in addition, it significantly reduced hot flashes. The findings were published online on July 29 in the Annals of Internal Medicine.

Researchers at nine academic medical centers enrolled 727 healthy women aged 42 to 58 who were no more than three years past menopause. They were randomly assigned to receive either: oral conjugated equine estrogens (Premarin), 0.45 mg/day, plus 200 mg oral progesterone for 12 days; a transdermal 17β-estradiol patch, 50 mcg/day, plus 200 mg oral progesterone for 12 days, or a placebo. The three regimens were continued for 4 years. Each year, the women underwent an ultrasound examination to detect changes in their carotid artery thickness and laboratory tests to measure cardiovascular disease risk.

The investigators found that 89.3% of the 727 women had at least one follow-up exam of their carotid artery thickness and 79.8% had the procedure at 48 months. The average increase in carotid artery thickness was of 0.007 mm/year for all three groups. The percentages of women in whom the carotid artery score increased did not differ significantly between the groups. No changes in blood pressure were observed with either oral estrogen or the patch. Low- and high-density lipoprotein cholesterol levels improved and levels of C-reactive protein and sex hormone–binding globulin but not interleukin-6 increased with oral estrogen. Insulin resistance decreased with the use of the patch. Serious adverse events did not differ by treatment.

The investigators concluded that four years of early HRT did not affect progression of atherosclerosis. In addition, it improved some markers of cardiovascular disease risk.

The researchers are affiliated with: the Kronos Longevity Research Institute and Phoenix Veterans Affairs Health Care System, Phoenix, Arizona; University of California, San Francisco, San Francisco, California; New York University College of Medicine and Columbia University College of Physicians and Surgeons, New York, New York; University of Utah School of Medicine, Salt Lake City, Utah; Los Angeles Biomedical Research Institute at Harbor–University of California, Los Angeles, Medical Center, Torrance, California; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle, Washington; Mayo Clinic, Rochester, Minnesota; Albert Einstein College of Medicine, Bronx, New York; University of Colorado School of Medicine, Aurora, Colorado; Yale University School of Medicine, New Haven, Connecticut; and Atherosclerosis Research Unit, University of Southern California, Los Angeles, California.