Reducing cardiovascular disease risk factors when discontinuing HRT

Hormone replacement therapy (HRT) has been shown to reduce many cardiovascular disease (CVD) risk factors, but many women have stopped using HRT due to reports from the Women's Health Initiative that HRT may increase the risk of breast cancer and heart disease.

In a study published in the June issue of the American Journal of Preventive Medicine, researchers from the University of Pittsburgh Graduate School of Public Health examined whether the increased CVD risk from stopping HRT could be minimized by lifestyle change intervention.

Participants were part of the five-year Women On the Move through Activity and Nutrition (WOMAN) study, a randomized clinical trial of CVD prevention. The focus of this investigation was 240 women who were taking HRT at baseline; 134 of these women were randomized to the lifestyle intervention and the remaining 106 were randomized to the health education group.

Participants were followed for 18 months. At 18 months, 110 (46%) of the women had continued HRT and the remaining 130 had discontinued HRT.

The lifestyle change group significantly decreased weight, Body Mass Index, waist circumference, total cholesterol and LDL-C, had improved fat intake and increased leisure physical activity, when compared to the health education group. In general, HRT discontinuation resulted in an increase in total cholesterol and LDL-C.

In the health education group, HRT discontinuers averaged over 22 mg/dL increase in total cholesterol and LDL-C while HRT continuers averaged less than 4 mg/dL increases. No such differences were observed in the lifestyle change group.

The lead author, Kelley K Pettee, Ph.D. currently a post-doctoral research associate at Arizona State University, states, "Considering the controversies regarding HRT, the findings from the present report are timely. These results have important public health implications and suggest that a non-pharmacological lifestyle approach is both safe and effective for CVD risk factor reduction in postmenopausal women, especially those who discontinued HRT use."

She continues, "CVD continues to be the leading cause of morbidity and mortality among women in westernized countries, Concern about the possible risks associated with HRT has left women and their heath care providers searching for safe and effective means to reduce CVD risk factors. One potential consequence of diminished HRT use is increased use of pharmacological agents, such as statins and aspirin; however, both are associated with side effects. Based on the findings of the current investigation, special attention should be paid to encouraging lifestyle strategies that are likely to impart more benefit and less risk than drug therapies."