Hormone Therapy & Your Heart Health: Are You at Risk for Cardiovascular Disease?

From the Show: HER
Summary: Recent research shows you may be able to reduce your risk of heart disease by taking estrogen.
Air Date: 2/19/15
Duration: 10
Host: Michelle King Robson and Pamela Peeke, MD
Guest Bio: Philip M. Sarrel, MD
Philip SarrelPhilip M. Sarrel, MD, 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.
Hormone Therapy & Your Heart Health: Are You at Risk for Cardiovascular Disease?
A recent study that was presented at the American Heart Association found that if women start taking hormone therapy within six years of menopause, they can significantly lower their risk of cardiovascular disease.

According to the Centers for Disease Control and Prevention (CDC), there are an estimated 720,000 heart attacks in the U.S. annually.

However, you may feel very hesitant to taking estrogen or any other hormone therapy, especially if you're approaching menopause, have already gone through menopause, or have had a hysterectomy.

The ELITE study followed 643 post-menopausal women, some of who had a prior hysterectomy. Half were close to menopause (roughly six years) and the other half were more distant (around 10 years). These women were randomly selected to take either 17 beta-estradiol orally daily for 12 weeks or a placebo. Women who still had their uterus also received 10 days of a progesterone vaginal gel.

Researchers found that over a period of six years, the women who were taking estradiol had overall slower progression of hardening of the arteries.

What else do you need to know about hormones and your heart health?

Dr. Philip Sarrel discusses the importance of estrogen, as well as the latest study between hormones and your heart health.

RadioMD Presents:HER Radio | Original Air Date: February 19, 2015
Hosts: Michelle King Robson and Pamela Peeke, MD
Guest: Philip M. Sarrel, MD

PAM: Alright. Let’s just get to the heart of hormone therapy. Come on.

MICHELLE: (laughter)

PAM: See, you’re laughing already.

MICHELLE: No, I have my own story.

PAM: Ah! Because you know hormone therapy and your heart health out there for you women on HER Radio, is what we’re going to talk about and are you at risk for heart disease—cardiovascular disease?

Dr. Philip Sarrel, our wonderful, dear friend is back again to help us all understand this relationship between hormone therapy and heart health. There has been all kinds of new news out there. A recent study presented at the American Heart Association found of women taking therapy within 6 years of menopause, they significantly lowered their risk of heart disease. According to the Center for Disease Control and Prevention, there are an estimated 720,000 heart attacks in the U.S. annually. We need to take this seriously. It’s not cancer. It’s all about heart disease.

Dr. Sarrel, welcome back to HER Radio.

Alright. Help us understand this relationship between hormone therapy and women’s hearts, especially in light of these new studies.

DR. SARREL: The first thing, of course, is to help people understand that heart disease is very important in women’s health and that more women die each year of a heart attack than men and more than 10 times--in fact, 12 times--as many women die of a heart attack each year versus breast cancer. It is far and away the leading cause of death. Fifty-three percent of all women die of minor cardio infarction and heart-related disease. All the rest only adds up to 47%. So, that’s the first point, I think, to make.

This is a very relevant topic for women’s health. It’s also important to realize that menopause makes a big difference because with menopause, women lose the protective effects of the hormones produced by their ovaries, protective in arteries. It’s rare, although not unheard of, for women before menopause to have a heart attack or die from a heart attack, but after menopause, the rates quickly start to increase and become almost those of men. And then, of course, in their later years, the women exceed the rates in men.

Prior to the menopause, about 1 out of 7 heart attacks--of all the heart attacks that occur each year--about 1 of 7 occur before menopause. They almost all occur either with the onset of menstruation or when a woman is ovulating. Now, we’re talking about young women. I’ve seen it in a 28-year-old nurse who had a heart attack; a 32-year-old doctor who had a heart attack; a 35-year-old gynecologist who had a heart attack. They almost all occur when there’s an acute drop in the estrogen production in their menstrual cycles. So, we shouldn’t forget about those women even though the vast majority, 86%, of all heart attacks are after menopause.

The study that you’re referring to, which was a National Institutes of Health sponsored proper, randomized clinical trial and reported. The lead of author of that is Dr. Howard Hodis of the University of Southern California. That study showed conclusively that women reaching menopause—whether it’s for hysterectomy and a surgical menopause at any age, or a natural menopause, which is around age 51—if they were to start to replace the missing hormones within 6 years of their last natural menstrual period or their last period altogether, they will slow the progression of the disease, which is called atherosclerosis. They will slow the progression of the disease that leads to heart attack and death from heart attack. Nothing else works that way. Statins is nowhere near as effective in women. Aspirin is nowhere as effective in women.


DR. SARREL: Either estrogen alone or estrogen combined with natural progesterone. Remember the USC study also showed women with a uterus were protected by a combination of the naturally occurring estrogen which is called estradiol and natural occurring progesterone and they showed these effects.

MICHELLE: So, Phil, a couple of things. I did a blog, as you know, on EmpowHer on “is estrogen the devil” and it was quite controversial because I had a heart condition myself because I didn’t have enough estrogen. So talk to me and our audience about the effects of estrogen and how it prevents heart attacks.

DR. SARREL: Okay. That’s a great question and I’ve spent the last 25 years of my life studying exactly those issues.

Estrogens act in arteries. So, remember, the estrogen is released by the ovaries, circulates in the bloodstream and works on the arteries themselves. The first thing it does is it inhibits the development of atherosclerosis. That’s what the Dr. Hodis study just showed but 50 years of research has shown the same thing.

My work has focused on the stress hormones, adrenaline being the most well-known, and how estrogen controls the release of those hormones and protects adrenaline from making arteries constrict. So, another set of actions has nothing to do with atherosclerosis. It has to do with inhibiting the reaction of an artery at a time of stress. Stress, we know, is very important and most programs that teach individuals how to prevent heart disease or how to prevent heart attacks do focus on stress reduction and what you can do about that.

Exercise is important. Diet is important. Stress control is important. But at the center of this, estrogen’s actions to inhibit stress responses from making arteries constrict is very important. Then, there’s a whole third--

PAM: Phil, if I can…Phil…Phil, if I can interrupt because we have precious little time. I want to make sure that women out there are getting this message. I think there was a huge flock of women who sort of discontinued everything after that Women’s Health Initiative study a number of years ago.

MICHELLE: Oh, yeah. Boy, did they.

PAM: Because they were scared. Oh, man. They were just gone. And then, the next thing that happened was we had women totally confused. Now, we have this new study and your wonderful work as professor emeritus from Yale University who’s devoted your life to this, telling us that, indeed, it’s okay and that we really need to consider hormonal replacement therapy to help prevent heart disease. Wouldn’t you agree, Phil, that each woman needs to sit down and have a really comprehensive conversation with their physician? We have just a minute left.

Can you just comment on that?

DR. SARREL: Okay. Well, women who are symptomatic are symptomatic with severe or moderately severe hot flashes. It’s very important to understand that persistent hot flashes are a risk factor for developing hypertension and subsequent heart disease. That’s a great starting point in the discussion with her physician—that she present herself with what she’s experiencing in her everyday life.

PAM: Got you.

DR. SARREL: That she understand it’s a problem.

PAM: And then really get down to those symptoms. Right.

DR. SARREL: That’s right.

PAM: I just can’t thank you enough. Michelle and I are so grateful that you’re always there.

Dr. Sarrel, professor emeritus from Yale University, helps us understand hormone replacement therapy and women’s heart health and whether or not you’re at risk for cardiovascular disease.

You can read more about Dr. Sarrel on the EmpowHer website.

Dr. Sarrel, thank you for being on HER Radio.

I’m Dr. Pam Peeke with Michelle King Robson.

MICHELLE: Ladies, it is so important that you take care of your heart first and foremost.

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Stay well.