Hormone Therapy,
Vitamins Don't Help Heart
Excerpt By Suzanne Rostler, Reuter's Health

NEW YORK (Reuters Health) - Antioxidant vitamins, either alone or in combination with hormone replacement therapy (HRT), do not appear to provide any heart health benefits to postmenopausal women, researchers said Tuesday.

In fact, the treatments may even be harmful, although more study is needed to determine if this is true, according to the report in the November 20th issue of The Journal of the American Medical Association.

In the study, 400 postmenopausal women with heart disease were randomly assigned to take HRT, vitamins C and E, a combination of the two, or inactive placebo pills.

Annual measurements suggested that artery narrowing was the same or slightly worse for women taking HRT compared with women taking a placebo, and for women taking the antioxidant vitamins compared with women taking the placebo. Rates of death, nonfatal heart attack and stroke were also higher among women taking HRT and vitamins than women taking placebos.

"The results of this trial add to the accumulating evidence that neither HRT nor antioxidant vitamin supplements improve the clinical course of coronary disease in postmenopausal women," the researchers conclude. "Postmenopausal women with coronary disease should be discouraged from using both HRT and high doses of vitamins C and E."

However, the dietary supplement's leading trade group criticized the design of the study and the interpretation of the results, charging that the findings could be due to chance. What the study really suggests, said Dr. John Hathcock from the Council for Responsible Nutrition (CRN), is that HRT and levels of antioxidant vitamins used in the study provide neither benefit nor risk.

"If the data were interpreted in the most straight-forward, obvious way, the study shows that there is no large benefit under these set of circumstances," said Hathcock, vice president of nutritional and regulatory science, in an interview. "But I conclude that there is no large set of concerns, either."

Dr. Jeffrey Blumberg, an antioxidant researcher at Tufts University in Boston, Massachusetts, agreed.

"There was no statistically significant difference one way or the other that you can conclude this study showed harm," he said in an interview with Reuters Health.

Indeed, the study authors note that the increase in death among women taking high doses of antioxidant vitamins "may represent a chance finding," and state that more research is needed.

Still, the findings contribute to a growing body of research that calls into question the much-touted benefits of HRT, long believed to lower the risk of heart disease among older women. While natural estrogen reduces blood levels of LDL ("bad") cholesterol and inhibits clotting, synthetic forms of the hormone do not appear to have the same effect, recent studies have revealed.

"Women seem to be protected from atherosclerosis (hardening of the arteries) by their own estrogen until menopause, but at least three studies now have shown that when we give postmenopausal women estrogen, it either doesn't help or it makes things worse," said Dr. David D. Waters, the study's lead author, in an interview with Reuters Health.

Similarly, eating foods rich in antioxidants, compounds that squelch disease-causing free radicals in the body, reduce heart disease risk, but providing the same vitamins in pill form may not have the same effect, said Waters, of the University of California, San Francisco.

In the study, women who were assigned to the HRT group took either estrogen (Premarin) or estrogen plus progestin (Prempro) if they had not had a hysterectomy. A second group took 400 international units (IUs) of vitamin E plus 500 mg of vitamin C, twice a day, or a placebo. Some women took both HRT and the vitamins and a fourth group of women took only placebos.

Waters recommends that HRT be used to control menopausal symptoms such as hot flashes and night sweats. Diet, exercise, blood pressure control, and quitting smoking may be more effective ways to lower the risk of heart disease, he said.

Blumberg from Tufts said that healthy postmenopausal women should look at the totality of evidence when it comes to taking antioxidant vitamin supplements.

"The totality of evidence, in my view, is that there is benefit and there is no harm," he said. "The data still says that this is a reasonable idea."

SOURCE: The Journal of the American Medical Association 2002;288:2432-2440.

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