Is your gynecologist against estrogen because of breast cancer risk? Or maybe because of a perceived increased risk of heart disease? Are you taking a statin to reduce your risk of heart disease?
Today I’d like to address the topic of heart health in menopausal women. Let me take a step back before I jump in. If you missed my first post on estrogen and why it doesn’t increase your risk of cancer, please read this (They Lied. HRT Doesn’t Cause Breast Cancer) and you’ll be up to speed on the current research around hormone replacement and breast cancer.
The following information is from my new favorite book, “Estrogen Matters” by Avrum Bluming, MD and Carol Tavris, PhD.
Did you know that heart disease is the leading cause of death of women in the US? In fact, in 2018, it is predicted that the number of American women who die annually of heart disease is more than seven times the number projected to die of breast cancer.
The primary signs of heart issues in women are greatly different than those of men. And it’s usually unrelated to chest pain for women. Signs and symptoms include discomfort in the neck, jaw, should, upper back or stomach, shortness of breath, pain in one or both arms, nausea, seating, dizziness, and extreme or unusual fatigue, all of which can indicate many different problems. Even when women do seek medical help, angiograms are often normal demonstrating no obstructive coronary artery disease.
Does Hormone Replacement Harm (HRT) the Heart?
A review of existing studies “concluded that most, but not all, studies of hormone replacement therapy in postmenopausal women show around a 50% reduction in the risk of coronary event in women using unopposed oral estrogen.” Other studies have shown that estrogen plus progestin was actually better than estrogen alone in reducing the risk of heart attacks. Remember the WHI study mentioned in the first blog post? Well, once again their contradictory findings about HRT and heart disease were almost certainly because the study was not based, as they claimed, on a sample of healthy women in their late forties and early fifties who were just entering menopause. Their median age was 63, 70% of them were seriously overweight and half were obese. Nearly 50% were past or current cigarette smokers, and more than 35% had been treated for high blood pressure. That means that atherosclerosis was probably present in the WHI population when the study began, So what the study really showed was starting hormone replacement 10 or more years after menopause offered little benefit.
The Truth About Statins
The Women’s cardiac Center in RI reports that stains are less effective in women than men. Their greatest benefit is in preventing a second heart attack and that they are more a marketing success story than a medical success. Many studies have shown that lowering cholesterol levels does not reduce the overall mortality rates of heart disease in women without cardiovascular disease. In women who already had cardiovascular disease statins can reduce the risk of nonfatal and fatal heart attacks. There is no relationship between total cholesterol level and death from heart disease, especially for women. This is not about LDL or triglycerides, which in high numbers can be a danger sign, but the overall total number of Cholesterol.
The Take Home
When HRT is taken at the start of menopause or before age sixty, it offers protection against coronary artery disease and heart attacks. Estrogen promotes healthy blood vessels and may help delay the formation of plaque. HRT is probably no protective on women who begin the use later, in their mid-sixties, although this conclusion is still being evaluated. HRT is potentially risky for women who begin taking it in their sixties, at least for the first year, especially if they have preexisting coronary artery disease.
Find a Specialist
As I’ve shared my story in the past. My gyno said I was too old and there would be no benefit to starting HRT, in my fifties. When I met with a hormone specialist, she said quite the opposite and suggested I read the Estrogen Matters book. So I strongly encourage you to find a specialist to help you with what you feel is best for you.
