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Helen Pensanti, M.D.

Quick Order Natural Hormones Dr. Pensanti Interview with John R. Lee M.D.

Hormones & Your Heart

Has your doctor told you that
synthetic hormone replacement will protect your heart?

THE STUDIES ARE IN - HE WAS WRONG

New Studies

According to the most recent studies, the myth has been exposed regarding estrogen and heart disease. Two studies which involved thousands of women have shown that synthetic hormone replacement INCREASES the risk of heart attack in postmenopausal women!

For the first time since I have been advising women to use natural hormones, the American Heart Association has agreed with me. Because the incidence of heart disease rises sharply in women after menopause, researchers believed that the female hormones were protective. They then theorized that synthetic hormone replacement would extend this protection. This theory was advanced when the 1995 PEPI studies that showed that estrogen replacement had a positive effect on lipids and clotting factors.

Many doctors immediately jumped to the conclusion that this would translate into fewer heart attacks. Even though they were warned by the National Institutes of Health that this was not proven, doctors all over the U.S. began to prescribe synthetic hormones for heart disease. They were wrong! There are 2 recent studies that were completed that give women this startling news.

The first trial was begun in 1994 and was called the Heart and Estrogen/Progestin Replacement Study (HERS) and was the second largest study of its type ever attempted. It was actually funded by the pharmaceutical company Wyeth-Ayerst who fully expected that HERS would prove their point that synthetic hormones prevent heart attacks in postmenopausal women. Two thousand women with heart disease were placed on Prempro which is a combination of Premarin and a synthetic progestin called medroxyprogestserone acetate. Four years later in 1998 the startling results were available: Prempro substantially increased heart attacks the first year AND it had NO effect on heart attacks in the subsequent years! There was a three-fold increase in risks of blood clots and in the first year of the study, a 52% increase in the risk of a heart attack. Gallbladder disease also increased. Of course we already know from the many studies I have given you that these women’s risk of breast cancer was increased by as much as 47%.

The researchers wondered if there was some “logical” explanation to these statistics. Perhaps characteristics more common in HRT users could explain the difference; things such as a healthier lifestyle or higher education. The National Heart, Lung, and Blood Institute (NHLBI) began a study called the Women’s Health Initiative or WHI. This is a $700-million national study of 160,000 women. Women were randomly assigned to either HRT or a placebo. On June 29, 2001, 4 years into the 81/2 year study, the HRT group had more heart attacks, strokes and blood clots than the placebo group. The extent of the increased risk is not yet known because the data has not been published, but women taking part in the study have been notified of their increased risk.

These studies were further advanced when researchers from Duke University reported the same findings. In their study, 37% of women who began taking synthetic hormones after their first heart attack were hospitalized for heart problems as compared to 17% of women who took no drugs. Most of the women in the study were on Premarin.

Another report published in the British Medical Journal analyzed 22 different studies and concluded that synthetic hormones do not prevent heart attacks. A separate study concluded that synthetic hormones increase the risk of a blood clot four-fold.

Now, there is evidence that the risk of blood clots seems to decline after the first year of using synthetic hormones and the jury is still out as to whether cardiovascular benefits may increase after years of use, but researchers concluded that women should NOT take synthetic hormones for heart protection.

Why Were The Original Studies Showing Estrogen Benefits Wrong?

Of course, mainstream medicine is now searching for an explanation, still feeling that they could not have been wrong about something that they thought was so promising. They seized on the idea that the synthetic progestin canceled out the effects of the synthetic estrogen, so perhaps they should have been given estrogen only-- exactly what raises the breast cancer risk!!

However, studies showed that there was no difference in heart attack incidence when the progestin was added to the synthetic estrogen. So now scientists are looking at the type of estrogen given -- perhaps Premarin was the culprit. This is why you now see all of these “designer” estrogens being formulated. However, they are still synthetic!! The most common one is a “patch” which they like to call natural because it is made from plants.

However, the estrogen derived from the plant is a synthetic and contains 17b-estradiol which has been found to lower cholesterol and elevate HDL. It does NOT contain estriol which is the weakest and most protective estrogen the body makes. Also, the studies are in their early phase and YOU must be the guinea pig.

One reason the old studies may have suggested a heart benefit is that the studies compared the health of women taking estrogen after menopause with those who did not. It appeared that those who took the estrogen had a lower risk of heart disease. However, researchers have now pointed out that this study was skewed because women who choose to take hormones differ from those who opt not to take them and it is that difference rather than the estrogen that accounted for the lower risk. Those women in the old studies might have been healthier on average to begin with.

It was not until a trial was done in which women were randomly assigned to HRT or a placebo that the question was definitively answered and we now see the increased risk.

What If I Already Know I Have Heart Desease? Should I Take The Cancer Risk And Take Synthetic Estrogen?

No, definitely NOT! One of these recent studies was called the Heart and Estrogen Replacement Study, or HERS. It specifically enrolled women with preexisting heart disease. Four years later there was no difference in the total number of heart attacks, strokes or blood clots between those who took synthetic hormones and those who did not. Also, in the first year the HRT increased their risk of cardiovascular disease.

Dr. David Herrington, professor of Cardiology at Wake Forest University School of Medicine in Winston-Salem, N.C. and co-author of the new heart and hormone guidelines said:

“I think we are accumulating an increasingly large body of evidence suggesting that women with heart disease are not benefited from hormone therapy with regard to heart disease.”

Natural Progesterone & Heart Attack

Even though after menopause women quickly catch up to the heart attack rate of men, the type of heart attack is different. Men suffer most of their attacks from clogged arteries. Women suffer more heart attacks that are caused by spasms of the heart muscle.

Dr. John R. Lee wrote of an extremely significant study in his book, What Your Doctor May Not Tell You About Premenopause. A landmark study was done on rhesus monkeys who have hearts that most closely resemble the human heart. The monkeys’ ovaries were removed to simulate menopause and they were then put on estrogen. Half of the monkeys were put on natural progesterone and half were put on medroxyprogesterone, a synthetic known as Provera. Four weeks later the monkeys were injected with some chemicals that would cause coronary spasm. The monkeys that were on the synthetic progestin suffered a severe form of spasm that would have caused their death if the doctors had not injected them quickly with a drug to reverse the spasm. The monkeys on natural progesterone suffered the spasm, but quickly recovered their normal blood flow and reversed the spasm naturally.

Remember, no matter what your doctor tells you, no matter how well-meaning he is, PROGESTIN AND PROGESTERONE ARE NOT THE SAME THING! Natural progesterone is REQUIRED for a healthy pregnancy; the body actually makes about 300 mg. of natural progesterone per day when a woman is pregnant. HOWEVER, progestins are absolutely contraindicated during pregnancy because they cause birth defects!!!!

Your Doctor May Not Have Knowledge Of These Studies

Although these new studies confirm what I have believed all along, it is new knowledge to many in the medical community. It may not have filtered down to many doctor’s offices yet, although the North American Menopause Society has acknowledged this data. For this reason I have compiled all of the studies for you to present to your physician.

What Can A Woman Do To Prevent Heart Attacks?

The truth is: there is no “magic bullet” for women when it comes to preventing coronary artery disease and heart attacks.

Women who are concerned about their heart must do the same things men have to do to maintain healthy hearts: watch their diet, avoid smoking, lower their cholesterol levels and maintain healthy blood pressure. According to leading cardiologists, relying on an estrogen pill was not a wise focus.

Folic Acid & B-6 For Heart Protection

A study published in 1998 gave some startling data regarding folic acid, Vitamin B-6 and heart disease. In a 14-year Harvard study of 80,000 healthy middle-aged women, it was found that women who consumed an average of 700 mcg. of folic acid per day (RDA is 180) and 4.6 mg of B-6 per day (RDA is 1.6) had cut their heart disease risk nearly in half!

First, let me say that this shows how pitifully behind the times we are with Recommended Daily Allowances. The current RDA’s set by the federal government were set in 1989. These values are under review and should actually be re-adjusted by now. Secondly, this is a very inexpensive supplement! (I have a product called Rodex Forte which contains these suggested amounts and costs only $18.00 for a 3 MONTH SUPPLY).

Researchers at the Harvard School of Public Health divided women into 5 groups based on their intake of folic acid and B-6. Among women with the highest intakes of the two vitamins, heart disease was 45% less common that among women with the lowest intakes.

Unpublished data from a large separate study of men by the Harvard Group found similar results.

How does it work? Both folic acid and vitamin B-6 help break down homocysteine which as we all know by now, plays a role in heart disease.

Other Nutrient For Heart Protection

Here are my other recommendations for heart protection:

  • Vitamin E: 400-800 IU daily
  • Vitamin C: 1000-4000 mg daily
  • Beta-Carotene: 20,000-50,000 IU daily
  • Co Q10: 60-120 mg daily for those without a specific heart problem
    120-300 mg daily for those with heart disease
  • Magnesium: 400-700 mg daily
  • Calcium: 1000-1500 mg daily (about twice as much as your magnesium)
    Copper: 2-3 mg daily
  • Zinc: 30-50 mg daily (ratio of zinc:copper should be between 10:1 and 15:1)
    Omega 3-6-9 Fatty Acids
  • Garlic: Fresh cloves are best
  • Others: Hawthorn Berry, Chromium, Lecithin

References

Colditz GA, et. al. 1990.
Prospective study of estrogen replacement therapy and risk of breast cancer in
postmenopausal women.
JAMA: 264:2648-53

Fremont L, et al. 1998.
Dietary flavonoids reduce lipid peroxidation in rats fed polyunsaturated or monounsaturated fat diets.
J Nutr 128:1495-502

Hemminki E, et. al. 1997.
Impact of postmenopausal hormone therapy on cardiovascular events and cancer: pooled data from clinical trials.
BMJ 315:149-53

Hertog MG, et al. 1993.
Dietary antioxidant flavonoids and risk of coronary heart disease: the Zutphen elderly
study.
Lancet 342(8878):1007-11

Hulley S, et al. 1998.
Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women.
JAMA 280: 605-13

Husken BC, et al. 1995.
Modulation of the in vitro cardiotoxicity of doxorubicin by flavonoids. Cancer
Chemother Pharmacol 37:55-62 (Ed note: contains in vivo data as well)

Ingram D, et al. 1997.
Case-control study of phyto-oestrogens and breast cancer [see comments].
Lancet 350(9083):990-4

Ishida H, et al. 1998.
Preventive effects of the plant isoflavones, daidzin and genistin, on bone loss in ovariectomized rats fed a calcium-deficient diet.
Biol Pharm Bull 21:62-6

Knekt P, et al. 1996.
Flavonoid intake and coronary mortality in Finland: a cohort study.
BMJ 312:478-81

Modena MG, et al. 1998.
Short-term results of transdermal estrogen replacement therapy in cardiovascular disease-free postmenopausal females with and without hypertension.
GItal Cardiol 28:636-44

O'Farrell S, et al. 1997.
Dietary polyunsaturated fatty acids, vitamin E and hypoxia/reoxygenation-induced
damage to cardiac tissue.
Clin Chim Acta: 267:197-211

Palace VP, et al. 1999.
Mobilization of antioxidant vitamin pools and hemodynamic function after
myocardial infarction.
Circulation 99:121-6

Ridgway T, et al. 1997.
Antioxidant action of novel derivatives of the apple-derived
flavonoid phloridzin compared to oestrogen: relevance to potential cardioprotective action.
Biochem SocTrans 25:106S

Rossouw JE. 1996.
Estrogens for prevention of coronary heart disease.
Circulation
94:2982-85

Sesso HD, et al. 1999.
Coffee and tea intake and the risk of myocardial infarction.
Am J Epidemiol 149: 162-7

Special Communication. 1973.
The Coronary drug project: findings leading to discontinuation of the 2.5
mg/day estrogen group.
JAMA 226:652-57

Wagner JD, et al. 1997.
Dietary soy protein and estrogen replacement therapy improve cardiovascular risk factors and decrease aortic cholesteryl ester content in ovariectomized cynomolgus monkeys.
Metabolism 46:698-705

Wilcox JN, et al. 1995.
Thrombotic mechanisms in atherosclerosis: potential impact of soy proteins.
J Nutr 125 (2 suppl):631S-38S

Wiseman H, et al. 1997.
The cardioprotective antioxidant activity of dietary phytoestrogens compared to oestrogen.
Biochem Soc Trans 25:107S

Yam D, et al. 1996.
Diet and disease-the Israeli paradox: possible dangers of a high omega-6 polyunsaturated fatty acid diet.
Isr J Med Sci 32: 1134-43

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