Mircette (Ethinyl Estradiol, Desogestrel)
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Other names: Apri
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HEART AT MENOPAUSE: STUDIES AND RESEARCHES
Just where did the idea come from that HRT (Hormone Replacement Therapy) could prevent heart problems? The history of this rather dubious claim, which is incessantly repeated in media reports on the benefits of HRT, illustrates only too well an old adage of Winston Churchill’s that there are lies, damn lies and then there are statistics. The study that started all this off was reported in the New England Journal of Medicine in 1985, with a follow-up in 1991. It looked at data received from questionnaires sent out to 121,700 nurses every two years over a period often years. Eventually the study was reduced to 48,470 post-menopausal women. Every two years the questionnaires were sent out, and the nurses filled in the details of their food and alcohol intake over that two-year period. This required a great deal of motivation from the nurses to keep accurate records over such a long time.
More to the point was the way the research programme was structured. Normally one group of women is randomly split into two groups; one group would be given HRT and the other a placebo (dummy pill). Then the women’s progress would be followed over a number of years to study the comparative risk of heart disease. But this is not what happened with the nurses’ study. There was no random selection of the groups in this case. One group was selected because they were already taking HRT and the other group was selected because they were not taking HRT.
It is very likely that those nurses who were at ‘high risk’, who had a history of heart disease or knew it was in their family would probably not have been prescribed HRT in the first place. The researchers actually found that in the group not on HRT there were 29.5 per cent more cigarette smokers and 29.6 per cent more diabetics, who could be assumed to be at a higher risk of heart attacks anyway. So there was what researchers call a ’selection bias’. The results came out indicating that women on HRT had a lower risk of heart disease. In this experiment it is likely only the healthiest nurses with a low risk of heart disease would be in the group taking HRT. Those at a higher risk of heart attack would, by definition, not be taking HRT. This is not the same thing as demonstrating that HRT protects against heart disease. Not by a long way. But it is the simplistic message that makes the headlines. And the HRT industry is only too happy to reinforce it.
So we can’t draw any firm conclusions from this study at all. Nor from the results of other US studies which appear to show that women on HRT have a lower risk of heart disease. In the States, the women who take HRT arc usually middle class, health conscious and comfortably off. They are likely to have less heart disease anyway. In fact in the very same issue of the New England Journal of Medicine which featured the nurses’ study mentioned above were details of another study showing that use of oestrogen substantially increased both heart disease and strokes,” and a review of a number of separate studies in The Lancet in 1991 concluded that the evidence for the preventative role of HRT in heart disease was either biased or insubstantial.
It also emerged that of the 48,470 menopausal women taking part in the study only 112 died of heart disease. That was 0.2 per cent of the total – far too small a sample to yield any worthwhile conclusions as to the preventative effect of HRT. Yet it was claimed that taking oestrogen had more than halved the risk of dying from heart disease. In fact nine out often of the nurses who died during the study succumbed to something other than heart disease.
This then is the basis of the claim, endorsed by some authorities in this country over the last few years, that taking HRT might reduce heart disease by 50 per cent. Amazingly, this claim became common currency, despite the fact that up to 1991 published results of research (done mostly in America) were based on oestrogen only (unopposed HRT). From 1975 onwards, with the scare about womb cancer, women in the UK have been given oestrogen plus progestogen (opposed HRT). Nowadays opposed HRT is the most commonly prescribed form of HRT. Until the results of a follow-up survey were completed in 1992 and not published until the summer of 1996 no one knew what the impact of added progestogen would be. Yet the confident message broadcast for years before was that HRT could prevent heart disease. Here is the conclusion of the published results: ‘The addition of progestogen does not appear to attenuate the cardio-protective effects of post-menopausal oestrogen therapy.’ In plain English it is saying that adding progestogen to the oestrogen does not appear to weaken the protective effects the oestrogen has on the heart. But as we have seen from the above, it is far from conclusive that oestrogen has any such protective effects. In fact, there are studies which show the reverse is true. A letter published in the New England Journal of Medicine in 1992 cited sixteen references which negated the claim that oestrogen can be protective against cardiovascular disease.
*74/101/5*
