HERS II: HRT Provides No Heart Benefits

July 3 -- Postmenopausal women who stay on hormones in hopes of reducing risk of heart disease may not get the benefits for which they once hoped.

A new study, the "Heart and Estrogen/Progestin Replacement Study II," or HERS II, shows that long-term use of hormone replacement therapy does not, in fact, protect women against heart disease. The results of the trial were published in this week's Journal of the American Medical Association.

The previously reported HERS I trial examined the role of hormone replacement therapy, or HRT, on heart disease risk in 2,300 postmenopausal women with heart disease. That study found that while HRT raised the risk of heart problems in the first year of treatment, it seemed to lower it during years three through five.

This finding had led to the widely held "don't start, don't stop" approach to HRT. That is, a woman should not consider initiating hormones for heart-protective reasons, but if she was already taking them and had weathered the first year's increased risk, she could be in a position to reap heart health rewards.

But now HERS II, which extended the follow-up of the previous trial to almost seven years, tells a different story. "It suggests that HRT should not be continued with the expectation that it is cardioprotective," says Dr. Brian Walsh, director of the menopause center at Brigham and Women's Hospital in Boston.

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Don’t Start, But Stop?

With no long-term cardiovascular benefits and demonstrated increased risk in the short term, some experts feel women should rethink their reasons for taking HRT, as well as the "don't start, don't stop" message.

"Right now, given what we know, any woman continuing on HRT should first of all question "Why [am I] taking it?" says Stacie Geller, director of the Center for Excellence in Women's Health at the University of Illinois, Chicago. "If she is taking HRT for long-term [problems] associated with aging, then she needs to reconsider. If it is secondary protection [of the heart], the data is clear: It does not work."