This Rx Combo Might Protect Hearts After Menopause

Hormone replacement therapy combined with statins may reduce deaths in menopausal women

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Women have a higher risk of heart disease after menopause, but a combination therapy may reduce that risk.

A new Swedish study found that among women who used hormone replacement therapy (HRT) and took statin medications, the risk of death from any cause was lower. Past research has indicated that HRT might increase the risk of heart disease in some women.

Angela DeRosa, DO, MBA, CPE, a member of the International Menopause Society and an associate professor at A. T. Still University in Kirksville, MO, told dailyRx News that women should be closely monitored when they start estrogen therapy after menopause.

"Estrogen may initially disrupt arterial plaque as it begins healing the tissues, raising the risk for a cardiovascular event," Dr. DeRosa said. "Women who are 8-10 years past menopause would not be good candidates for estrogen therapy."

The authors of the current study noted that Swedish women use a specific type of HRT that may be different from what doctors in the US prescribe.

This study was led by Ingegard Anveden Berglind, MD, PhD, of the Center for Pharmacoepidemiology at the Karolinska Institutet in Stockholm.

Statins (brand names include Zocor, Pravachol, Lipitor and Crestor) are used to lower cholesterol.

The two major female sex hormones are estrogen and progesterone. During menopause, estrogen levels in the body start to diminish.

HRT is used to help decrease unpleasant symptoms of menopause like hot flashes. HRT may include estrogen, progesterone or a combination of the two.

Dr. Berglind and colleagues used data from the Swedish National Patient Register and the Swedish Prescribed Drug Register. More than 78,000 women aged 40 to 74 were included in this study.

These patients were all living in Sweden and filled a first statin prescription between 2006 and 2007. About 70 percent of the women in this study used statins.

Dr. Berglind’s team followed the patients for about four years.

During that period, more than twice as many women who were not taking statins died, compared to those who were taking statins. Deaths from heart disease among women who did not use statins were more than three times higher than among women who used statins while on HRT.

Dr. Berglind and colleagues noted that all the women in the Swedish study used a type of HRT called 17-A estradiol, the only type of HRT available in Sweden. In two past large studies that indicated HRT might increase the risk of heart disease, women used a type of HRT called conjugated estrogens.

Dr. Berglind and team speculated that estradiol might be less likely to cause heart disease than conjugated estrogens. They also noted that women on both HRT and statins might receive more frequent medical care, which could result in early treatment of heart disease and decrease the death rate.

The overall number of deaths in this study was low, and Dr. Berglind and team were unable to assess for smoking status, which could also affect heart disease risks.

This study was published online March 17 in the journal Menopause.

Although this study was not directly funded, it was developed from a project sponsored by AstraZeneca, Merck, Sharpe and Dome and Pfizer — all of which make statin or HRT medications.

Study author Dr. Morten Andersen received fees from Mediacademi and the Danish Association for the Pharmaceutical Industry for leading courses and teaching pharmacoepidemiology.

Review Date: 
March 18, 2015
Last Updated:
March 24, 2015