Dr. Sarrel describes the relationship between hormones and an increased risk for heart disease in women.
The relationship between hormones and heart disease in women is pretty clear. The question is, is there any evidence that women who take hormone, like estradiol, help prevent heart disease? And the answer is yes, there is - very important to know.
There are many studies, especially in young women. So women who have had premature ovarian failure, women who have had their ovaries taken out at an earlier age like in their 30s or 40s, those women, given replacement of the missing estradiol, show a major decrease in heart attacks, compared to women who haven’t done that.
A major study in this country looking at heart disease and taking hormones is called the Women’s Health Initiative study. That study was actually put in place as a cardiac disease study. The reason was that once it was discovered that women die of heart attacks and that’s that Mayo Clinic work from the 1950s and the early 1960s, between then and the year 2000 about a thousand studies were done showing that the estrogen protected arteries and there were studies showing it reduced the occurrence of heart attacks.
The Women’s Health Initiative studied two groups of women – one group had no uterus and they were given estrogen only, compared to placebo, and when the study’s results were reported they reported there was no decline in heart attacks for the women just getting estrogen. However, they also reported that in that study there were women in their 50s, almost 2,000 of them who, indeed did show a reduction in heart attacks.
The thousand studies done between 1950 and the year 2000 basically show that a woman who used estrogen through the menopause reduced the risk of a heart attack by about 35% and guess what, the Women’s Health Initiative studies of women between the ages of 50 and 60, in that study, showed about a 35% reduction in the occurrence of heart attacks; exactly what the old medical literature had shown. It proves the point.
But most of the women in the Women’s Health Initiative were over the age of 60. The average age was 63 and it did show that in the women who took estrogen alone for seven years, regardless of their age, there was no increase in heart attacks. This is often confused in the minds of doctors and of women because an earlier report from the Women’s Health Initiative in which the women had a uterus and took estrogen along with a hormone progestin, which opposed the estrogen, they showed an increase in heart attacks, and that makes a lot of sense because what the progestin does is wipes out the effects of the estrogen.
The problem is that because of the way the media handled all of this and the impact that it had on our society is everyone has now come to believe that estrogen doesn’t help the heart when the opposite is true. It’s extremely important in protecting the heart.
So let’s take a case that a doctor referred to me recently, within the last week. Almost every day some doctor somewhere in the country has a patient connect to me by the Internet and I am always available to respond to that. So a doctor in Rochester, New York sends the following story:
He says, “I have a patient who is 54 years old. She has a lot of symptoms related to estrogen-deficiency. I have been treating her with an estrogen patch but she had a heart attack – very mild, and I have continued her on the estrogen patch knowing that it protects her heart.”
“Her cardiologist fully supports what I am doing and she is functioning very well at her work and every day with her estrogen patch protecting her heart, but her internist believes part of that Women’s Health Initiative that it was bad for her heart and he wants her to stop. What do I do?”
So I replied to him in an email that covered about 20 minutes of information – here are all the studies that show how what you are doing is helping her to prevent another heart attack, and doctors and women across the country need to know and understand this. It’s very important.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.