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Decline in HRT use 'has led to fewer heart attacks in women'

By Nigel Praities

Declining use of hormone-replacement therapy has resulted in fewer women having heart attacks, the first large-scale ‘real world' study to look at the issue has concluded.

Researchers estimated the impact of HRT use on the general US population and confirmed clinical studies showing a link with worse cardiovascular outcomes.

Analysis of the records of a representative sample of US women aged 40 to 79 showed an estimated 25 myocardial infarctions per 10,000 person-years were prevented due to the fall in HRT use since 2002.

Although no significant association was found between HRT use and stroke rates, the researchers said they could not exclude a ‘small effect'.

HRT use has plummeted since the 2002 release of data from the Women's Health Initiative which showed a 29% increase in the risk of coronary heart disease in women on HRT.

GP prescribing of HRT in the UK dropped by 15% in the following year.

Dr Kanaka Shetty, lead researcher on the study from Stanford University, California, said the results came from the ‘natural experiment' of declining HRT use in the US.

‘HRT use is unlikely to provide meaningful cardiovascular protection to the typical user. However, … short-term use for alleviation of postmenopausal symptoms may be warranted depending on symptom severity and prior risk for side effects.'

Dr Sally Hope, a GP in Woodstock, Oxford, and a founding member of the Primary Care Group in Gynaecology, said the results added to the substantial evidence against the use of HRT.

‘This is another nail in the coffin for HRT. There has been a huge sea-change in this country and I can't remember the last time I prescribed HRT to anyone,' she said.

Dr Martyn Walling, a GP in Spalding, Lincolnshire, with a special interest in womens' health, said the results went against recent studies that showed cardiovascular benefit with HRT.

‘There are so many factors here and you can find papers that say the opposite. In America, often they put older women on HRT – which we just don't do in the UK. These studies have caused an enormous amount of harm,' he said.

The study appears in the latest edition of Medical Care.

HRT use has plummeted since 2002 findings showing it raised cardiovascular risk Evidence on HRT, a timeline

Jul 2002: Women's Health Initiative trial shows a 29% increase in the risk of coronary heart disease and a 41% increase in stroke in women aged 5t to 79 years taking HRT, compared with those who were not

Jul 2007: Australasian study shows older women starting HRT many years after the menopause have an increased thromboembolic and cardiovascular risk

Aug 08: WISDOM study re-opens debate on HRT after showing significant improvements in sexual functioning, sleep problems, hot flushes, night sweats, aching joints and muscles, insomnia and vaginal dryness compared with placebo

Feb 2009: US researchers find a 50% decline in HRT use coincided with a 43% fall in breast cancer rates between 2002 and 2003

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