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CNN Live At Daybreak

Is Hormone Replacement Therapy Safe for Women?

Aired July 24, 2001 - 07:36   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
COLLEEN MCEDWARDS, CNN ANCHOR: Some health news for you this morning. A new worry for the millions of women who take hormone supplements. There's growing evidence that hormone replacement therapy can actually harm some women who take supplements to prevent strokes and heart disease. Now the American Heart Association has issued new guidelines.

Here's CNN's medical correspondent Rhonda Rowland.

(BEGIN VIDEOTAPE)

RHONDA ROWLAND, CNN MEDICAL CORRESPONDENT (voice-over): It's the most expensive and far reaching study ever conducted on women, the 15- year long Women's Health Initiative. Just one of the questions being answered, but perhaps the most controversial, can hormone replacement therapy protect women from heart disease?

UNIDENTIFIED FEMALE: That the women on active hormones had a small increase in the number of heart attacks, strokes and blood clots.

ROWLAND: It came as a surprise. An interim report from the study showed hormones slightly increased the risk of cardiovascular problems in healthy women. That finding joins recent data on hormones and heart disease that conflict with earlier conclusions that suggested, as a group, women on hormones have fewer heart attacks.

DR. NANETTE WENGER, EMORY UNIVERSITY: The documented risks have essentially been an odyssey of discovery and much of this is fairly recent.

ROWLAND: So now, the American Heart Association is advising physicians to steer clear of prescribing hormone replacement therapy for the sole purpose of preventing heart attack and stroke in women who already have cardiovascular disease. For women with heart disease who have been taking hormones for some time, the guidelines recommend weighing other benefits such as relief from hot flashes or prevention of osteoporosis and other risks such as blood clots and possibly breast cancer.

WENGER: When women ask me, as they likely ask many of their treating physicians, can't you make up your mind? Hormones were good, now hormones are bad or neutral. My reply is that I want my patients today to have the best available information that I have. ROWLAND: For healthy women now taking hormones, the information suggests there's no need to make a change.

DR. LAWRENCE PHILLIPS, ENDOCRINOLOGIST: I'm still telling them that the weight of the evidence considering breast cancer, considering osteoporosis, considering coronary artery disease, they should take estrogens.

ROWLAND (on camera): Decision of whether to use hormones is not an easy one and it must be made individually. If you're concerned about heart disease, the American Heart Association recommends the basics: lower your blood pressure and cholesterol, eat right and get enough exercise.

Rhonda Rowland, CNN, Atlanta.

(END VIDEOTAPE)

MCEDWARDS: We get more on this now with a special guest, Dr. Lila Nachtigall, who is the author of a book called "Estrogen" -- quite an authoritative book on this whole issue.

Dr. Nachtigall, thanks for being here this morning.

DR. LILA NACHTIGALL, AUTHOR, "ESTROGEN": Glad to be here.

MCEDWARDS: OK. So if a menopausal woman is waking up this morning, someone who is at risk of heart disease or stroke, what should she do?

NACHTIGALL: Well, I think it is a complicated issue. And someone just said very correctly, it's an individual decision.

I think the only recommendation that was changed was that if you've just had a heart attack that you should not go on estrogen at that time. And that makes a lot of sense, because women who have just had a heart attack are sick. A heart attack is very serious. They obviously have a damaged heart. The heart can't pump as well as it used to and it's a very different state. But all the studies have shown if time goes on, these women do fine.

And there's a very interesting article that also came out today in the archives of the internal medicine that shows if you take those same women and start them one year later, they have a reduced risk of a second heart attack.

So I think you really have to stay within very narrow guidelines and guidelines are for the general population. But your own doctor can help you with your individual decision. Certainly a women who's already been on estrogen for more than a year, whether she's had a previous heart attack or she's a healthy woman, should stay on her medication.

MCEDWARDS: Doctor, why these conflicting conclusions? Help us understand what happens between one study and another because it always seems there's so much out there. One moment you hear one thing and at another moment you hear another which makes those individual personal decisions so difficult.

NACHTIGALL: It really does. I think it's very complicated and I think it's interesting because probably estrogen has been studied more than any other drug and every aspect has been look at and that -- and it works on every part of your body. I think when you look at something like statins, which are wonderful for reducing heart disease and helping make a better cholesterol pattern, nobody's ever looked at what it does to breast cancer or anything else.

So you look at estrogen where they look at what it does to hair and skin and breast and heart and lung and bone, you're going to get a lot of different aspects.

MCEDWARDS: If I understood the literature I read this morning correctly, it sounds like there are still a couple more studies to come on this, though, right, in the next five to eight years so, so could this change again?

NACHTIGALL: I'm sure it can change again. The Women's Health Initiative was started to be a 12-year study and they're not going to get their final answers until 2005. So the preliminary that you're hearing is very preliminary and we really do have to wait for the long-term issues.

One of the big problems is the heart doesn't just work as a muscle, a lot of what's going on depends on clotting. And estrogen's affect on the heart muscle and on circulation is good, but its effect on clotting, if someone has an abnormality of this clotting, is not good. So you need to weed out the women who are at high risk for clotting -- women who have had a previous episode, for example.

MCEDWARDS: All right, understood. So it sounds like you really, really need the advice of your doctor on this issue.

And, Dr. Lila Nachtigall,...

NACHTIGALL: That is so true.

MCEDWARDS: Yes.

Thank you so much for your advice and your thoughts this morning. Appreciate it.

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