Could a blood test help women decide about HRT?
Publication Date:23/05/2008
A simple blood test may be able to tell women if they're at risk of one of the serious side effects of HRT.
Some menopausal women who take HRT have a slightly higher risk of a heart attack. But if a blood test shows that a woman has a healthy cholesterol level, her risk of a heart attack is no higher than a woman who isn't taking HRT, a new study has found.
What do we know already?
Hormone replacement therapy (HRT) is a treatment that helps prevent symptoms of the menopause, such as hot flushes. Unfortunately, taking HRT can also increase the risk of some serious side effects. For example, it can increase your risk of a heart attack, a stroke, breast cancer or a blood clot.
The risk of side effects from HRT goes up the longer you take it, then drops back to normal a few years after you stop. The risks are small for most women, but the chance of getting side effects can still make it difficult to decide whether to take HRT or not. You and your doctor need to carefully weigh up the individual risks and benefits of treatment for you.
Researchers have now looked at a group of 271 women who had heart attacks while taking HRT. They compared them with women who didn't get heart problems while taking HRT. The idea was to see if there were any differences between the women that might help researchers predict who is likely to get side effects from this medicine. All the women in the study were over 50 and had already been through the menopause. They were taking either combined HRT (oestrogen and a progestogen) or HRT with oestrogen alone.
What does the new study say?
The study found that women with healthy levels of cholesterol in their blood at the start of the study weren't at any higher risk of a heart attack if they took HRT. But women who had less healthy levels of cholesterol were more likely to have a heart attack if they took HRT than if they didn't.
There are two types of cholesterol in your body, often called 'good' and 'bad' cholesterol. The more you have of the 'good' kind, the better. In this study, women didn't have a higher risk of a heart attack as long as their level of 'bad' cholesterol was less than two-and-a-half times that of their 'good' cholesterol.
Although the new research can help predict whether a woman is at risk of a heart attack if she takes HRT, it doesn't give any information about the risk of other side effects, such as breast cancer or a stroke.
Where does the study come from?
The study is part of a larger research project called the Women's Health Initiative, which looked at tens of thousands of women from all over the United States. It appeared in The American Journal of Cardiology, which is published by a company called Elsevier.
How reliable are the findings?
The study was done well. It forms part of a much larger piece of research, which looked at tens of thousands of women. The researchers then looked at a smaller group of women who'd had heart attacks.
The researchers also took into account the other things that could have increased the women's risk of a heart attack. They adjusted their results to compensate for the fact that some women were older, smoked, had high blood pressure or were overweight.
What does this mean for me?
For most women taking HRT, the risk of having a heart attack is small. Previous research has suggested the extra risk only affects women over 60.
This new study suggests that, if your cholesterol level is healthy, you're at no extra risk of having a heart attack if you take HRT. Together with a cholesterol test, this information may help you decide whether to take HRT or not.
Unfortunately, HRT can also have other side effects, such as increasing your risk of breast cancer, a stroke or a blood clot. The current study doesn't tell us whether anything can predict your risk of these side effects.
What should I do now?
If you're considering taking HRT, or you're already taking it and are worried about side effects, make an appointment to talk to your doctor. He or she may be able to explain how all the risks and benefits affect you as an individual.
If you want to find out your cholesterol level, it can be checked using a simple blood test. The best place to start is your GP, although some pharmacists offer cholesterol testing and you can also get kits to test yourself at home. You shouldn't have anything to eat for about 12 hours before your test, as this can affect the results.
If you do take HRT, it's recommended you take the lowest dose that works for you, and that you stop taking it as soon as you no longer need it. This cuts the risk of harmful side effects.
From:
Bray PF, Larson JC, LaCroix AZ, et al. Usefulness of baseline lipids and C-reactive protein in women receiving menopausal hormone therapy as predictors of treatment-related coronary events. The American Journal of Cardiology. 2008; 101: 1599-1605.
To read more, see our information on the menopause.
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This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
