As they progress to menopausal age the women undergo hormonal changes that increase the risk of heart disease, which includes an increase in body fat as well as high amounts of “bad” LDL cholesterol. Recent studies have shown that the kind that hormone replacement treatment (HRT also known as the HT) and the timing the time it is administered can affect the likelihood of women developing heart disease.
Hormone Therapies Differ; Women’s Needs Differ
“The main takeaway is that all hormone therapies are not the same, and it’s not that one is good and another is bad,” says Stephanie Faubion, MD, MBA, who is the director of the women’s health center within the Mayo Clinic in Rochester, Minnesota. She says Dr. Faubion was not involved in the research. “We need to take these differences into account when we look at each individual woman, to determine what therapy is best according to her needs and what her risk factors are,” she declares.
Women Face Greater Risk of Heart Disease in Midlife
The most common cause of death among women and the risk for developing it is higher after 50 years at which point many women become menopausal. This is a situation that is discovered in retrospect after the woman hasn’t been able to have her period for 12 consecutive weeks.
The Role of Estrogen in Heart Health
Estrogen is the hormone created by the ovaries of women. It is a heart-protective hormone However, as women get older and begin menopausal the ovaries of women produce less estrogen.
In the initial study, that was published within the issue of March, 2020 of Menopause the results indicated the possibility that hormone replacement therapy using the oral conjugation of equine estrogens might be protective on heart health when compared to transdermal estradiol or any hormone therapy in any way.
Researchers analyzed data from 467 women in menopausal who been part of the Kronos Early Estrogen Prevention Study (KEEPS) A randomized study that was controlled by placebo. In order to be eligible for the study, women needed have a healthy uterus, age in the range of 42-58 and also have experienced their last menstrual period between 6 and 36 months prior (so that it was less than three years prior to menopausal symptoms began).
It’s important to remember this: the quantity of estrogen utilized in the study was a lower amount than what was employed in the Women’s Health Initiative study (the 2002 study that linked the use of combined hormone therapy including progestin and estrogen — to a greater risk of breast cancer, heart disease and other health issues).
Fat Accumulates in Midlife
It is known that as women move through menopausal changes it is likely that they will develop abdominal visceral fat, as well as excess heart fat, as per Samar R. El Khoudary, PhD MPH who is who is an assistant professor in epidemiology of the University of Pittsburgh Graduate School of Public Health in Pennsylvania and the principal author for the research study. The accumulation of fat around the heart has been associated with the progression of atherosclerosis.
To determine whether estrogen can affect the formation of heart fat and the progression of atherosclerosis assessed the thickness of the carotid artery intima-media (CIMT) and as the amount of heart-related fat during a 48-month time.
Researchers split females into 3 groups in order to assess how the effects of the three groups could affect the development of CIMT and the accumulation of fat in the heart. One group received 0.45 milligram (mg) daily of orally conjugated equine estrogens (CEE) and the other group received 50 micrograms daily of transdermal 17 beta-estradiol another group was given an placebo.
Researchers employed CAT scans in order to assess epicardial adipose as well as paracardial adipose tissue and CIMT in the beginning and at 48 months. CEE as well as 17 beta-estradiol can be utilized (sometimes in conjunction with the progestin) to treat menopausal symptoms, such as vaginitis and hot flashes or insomnia.
Gauging Heart Health in Midlife Women
Carotid intima media thickness is a measurement used to assess the degree of carotid atherosclerotic disease, which is usually due to atherosclerosis. Atherosclerosis is a condition that occurs in where plaque forms inside the arteries. It’s the primary cause of many cardiovascular illnesses or conditions like heart attacks stroke, heart attack or even death according to the National Heart, Lung, and Blood Institute.
Tests for CIMT examine how thick the outer two layers in the carotidartery that can indicate a the presence of thickening, even when a person hasn’t noticed any signs at the moment. The carotid arteries comprise two blood vessels of a large size located in your neck, which supply blood to the brain.
Researchers discovered that when compared to the estrogen patch or placebo treatment, CEE oral decreased the negative effects of a rise in pericardial fat build-up within the heart area in atherosclerosis (it did not reveal any difference in the way that another type of epicardial fat was affecting atherosclerosis). Another study has revealed that there is a connection to the quantity of the fat in the pericardium and risk of developing coronary heart disease.
The findings are in line with what we’ve observed previously of this SWAN study, according to Professor. El Khoudary. The Study of Women’s Health Across the Nation (SWAN), released in September of 2015 within the journal of clinical Endocrinology and Metabolism, Dr. Khoudary’s team discovered that as levels of the sex hormone estradiol (the most powerful estrogen) decreased in the transition from perimenopausal to post-menopausal age, there were more cardiovascular fats even after they had controlled by Body mass index (BMI) as well as physical activities.
“Our new findings in KEEPS support the role of estrogen in how this fat could hurt or impact the functionality of the heart,” El Khoudary explains. The treatment of hormones can alter the connection, based on the formula of the therapy as well as the method of administration, she says.
The Hormone Treatment Versus How the Hormone Is Delivered
It’s not clear if the higher level of protection shown by oral CEE is due to the estrogen type or because it was administered orally. the less effective estradiol was administered through the skin via a patch, according to Khoudary. This contradicts the results of earlier research that found that the transdermal estrogen (delivered through a patch applied to the skin) might have greater cardiovascular health benefits than oral treatments.
“This is because these studies were originally designed before there was strong evidence that showed that hormone therapies differed from each other,” she states. More research is needed to determine if it’s the estrogen type or the method of administration which slows down the growth of carotid media intima thickness El Khoudary says.
Hormone Therapy Around Menopause: Women Need to Demand More From Doctors
“The study emphasizes that we should not keep using the term ‘hormone therapy’ for every single formula or route of administration, as there are many in the market,” El Khoudary explains. “As we conduct more studies we discover that they’re not all alike, and they’re not all alike in the way they affect the cardiovascular and risk. This study proves this,” she says. The effect of hormones really is dependent on the specificity of the formulation as well as the delivery method She adds.
Earlier Intervention With Hormone Therapy Provides Greater Benefit
Another recent study suggests that the time of commencement of hormone therapy can make an impact in slowing down the development of atherosclerosis (a accumulation of plaque in the arteries, which could cause a type that is heart-related).
The ELITE trial, which was published at the end of 2016 by the New England Journal of Medicine evaluated the effect the hormone treatment in IMT thickness (a measurement of the extent to which plaque is being deposited in arteries) for women who were younger than 6 years after menopausal symptoms as compared to women more away from menopausal symptoms, for at minimum 10 years. Women who were closer to menopausal were more likely to experience a slower progression in atherosclerosis, as measured in IMT thickness, however, older women didn’t.
These findings confirm the hypothesis of timing when to start hormone therapy that were developed around 10 years ago, according to Roksana Karim MD who is an assistant professor in the department of preventive and clinical medicine, within the Keck School of Medicine at the University of Southern California in Los Angeles and the lead researcher of the study.
“It shows that women who are closer to menopause respond better to hormone therapy compared with those who are further away from menopause,” says Dr. Karim.
To determine the cause of this change the researchers took information from ELITE study to determine the concentrations in the bloodstream of 12 different markers for inflammation. Their findings were presented during the 2020 Virtual Annual Meeting of the North American Menopause Society (NAMS) that began on the 28th of September.
Researchers found that four of the 12 indicators of inflammation (E-selectin ICAM-1, IFNg, and the IL-8) had significantly decreased in women who were on HT who were six years or less away from the beginning of menopausal symptoms than the group that was a placebo. For the group that was 10 years or more from menopausal onset there was only one marker, E-selectin had a significant decrease compared to the group of placebo.
“These results further support the finding of the primary ELITE results, and show that hormone therapy reduces the level of inflammation,” Karim says. Karim.
The anti-inflammatory properties of hormone therapy may be the cause behind the improvement in atherosclerosis that comes due to hormone therapy found in the ELITE study, she adds.
There Are Many Different Types of HT, and the Differences Matter
The dangers and benefits of hormone therapy can be altered substantially by all of these factors, Faubion agrees. “So, when people say hormone therapy is ‘good’ or ‘bad’ and make it a black or white thing, it completely misses the point,” she declares.
“We’re just getting to customize the therapy we provide to every woman, which is a major, significant leap forward for us. It is essential to find a doctor who is aware of the dangers and advantages of all different kinds of hormone therapy” says Faubion as the director medical of the North American Menopause Society.
The best way to accomplish that is to go to your local North American Menopause Society at Menopause.org according to Faubion. Menopause.org has doctors’ locators to help you locate an expert who has passed an NAM Practitioner certificate.
Advocate for Personalized Treatment That Addresses Your Individual Risks
Women should insist on more from their doctors according to Faubion. “We need to empower women to say, ‘If you’re not individualizing hormone therapy for me and taking into account my cardiovascular risk and my breast cancer risk, then I need to find another provider,'” Faubion states.
Faubion warns women not to alter the hormonal therapy they’re currently on due to the latest research. “This research identifies that there are important differences that need to be further fleshed out, but I wouldn’t recommend that anyone jump off what they’re taking or switch to anything else based on these findings,” Faubion says. Faubion.