HRT May Reduce Risk of Peripheral Artery
THURSDAY, June 16 (HealthDay News) -- The use of hormone
replacement therapy (HRT) appears to help protect postmenopausal
women against the development of peripheral artery disease, new
The risk reduction for peripheral artery disease, or PAD, was
found even though the group of women on HRT were more likely to
have conditions such as high cholesterol and high blood pressure,
the researchers reported.
"We found that patients who had used HRT were about 20 percent less likely to have PAD," said study author Dr. Caron Rockman, an associate professor of surgery at the NYU Langone Medical Center in New York City.
She is slated to present the findings Thursday at the annual
meeting of the Society of Vascular Surgery in Chicago.
PAD is a narrowing of the peripheral arteries, usually those in
the legs and pelvis. Most often, the symptoms are cramping, pain or
tiredness in the leg or hip muscles noticed while walking or
climbing stairs. PAD increases the risk of heart attack or
The risks and benefits of HRT have long been debated. In 2002,
results from the large-scale Women's Health Initiative were issued.
Those researchers concluded then that the therapy did not protect
the heart and the risk-benefit ratio did not favor using it to
prevent chronic disease.
More recently, however, the International Menopause Society
issued a review stating that HRT remains effective for treating hot
flashes and other menopausal symptoms. When individualized, the
therapy may have benefit for heart health, those experts said, in
women under age 60 when taken short-term.
While previous research has looked at the effect of HRT on PAD,
the association is not yet clear, Rockman said. In her study, she
looked at a large database of women who underwent vascular
screening for PAD.
In all, she evaluated almost 848,000 women; about half reported
having used HRT and half had not.
Women who used HRT were more likely to be white, to have smoked
cigarettes and to have high blood pressure and high cholesterol. In
addition, those on HRT were slightly older (about 64.7 years old on
average) than those who were not on HRT (about 64.3 years old).
The investigators also found that those who took HRT were also
less likely to have PAD, even with their increased vascular risk
factors. While 3.3 percent of those on HRT had PAD, 4.1 percent of
those not on HRT had it, they reported.
When Rockman controlled for other factors that could have
explained the decreased PAD risk, she found that HRT was linked
independently with the reduced risk.
The study has limitations, Rockman noted. "We don't know what
type of HRT these patients took and for how long," she said. The
patients were also self-referred, or women who chose to undergo
screening. So something about a self-referred group could have
affected the findings.
While the exact mechanism of the link between HRT and reduced
risk of PAD isn't known, Rockman said other research has shown that
HRT may dilate peripheral blood vessels.
However, the benefit of reducing PAD risk should not at this
time be the sole reason for giving HRT, said another expert, Dr.
John Stevenson, of Imperial College London. He reviewed the study
but was not involved in it.
"The finding would be yet another benefit to explain to women contemplating starting HRT for other reasons, and especially if they had a family history of peripheral vascular disease," Stevenson said. "But I think we would need a randomized clinical trial to make prevention of peripheral arterial disease a sole indicator for giving HRT."
Rockman agreed that the pros and cons of HRT need to be put in
perspective. "We are certainly not saying that HRT should be given
to all to prevent PAD," she said, pointing out that there are
potential risks with HRT use.
According to the International Menopause Society review, those
who take both estrogen and progesterone do have a slightly
increased risk of breast cancer, for instance. But those who do not
have a uterus can expect reduced risks of breast cancer and heart
disease if the therapy is short term and individualized, said the
experts writing the review.
Because Rockman's study was presented at a medical meeting, the
data and conclusions should be viewed as preliminary until
published in a peer-reviewed journal.
To learn more about PAD, visit the
American Heart Association.
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