Expert believes early HRT can have heart benefits

LONDON, Dec 22 (Reuters) An expert on women's health believes hormone therapy, given at the right time, can protect against heart disease, despite a study four years ago linking it to an increase in heart attacks and strokes.

Professor Virginia Miller of the US Mayo Clinic College of Medicine believes timing is key and menopausal women given hormone replacement therapy (HRT) early are likely to benefit from a reduced risk of heart disease.

Leaving treatment until 10 years or so after the menopause, however, may be counter-productive.

''There seems to be protection if you begin treatment between the ages of 50 and 58. If you begin the treatment late, that is when harm is found,'' she told reporters before addressing a meeting of the British Pharmacological Society in Oxford this week.

''What we are interested in is defining the proportion of the population who may benefit.'' Until 2002, most data suggested that HRT was associated with a 30 per cent or more reduction in heart disease risk, as well as a lower risk of osteoporosis, although there was a small increase in breast cancer risk.

That view was turned on its head by the US government-funded Women's Health Initiative (WHI) study, which caused millions of women to abandon HRT and hit shares in makers of hormone therapies such as Wyeth.

In fact, Miller believes the conclusions of the WHI study are more complicated than first thought. She points to growing evidence from observational studies suggesting that early use cuts heart risk.

Now she hopes to prove the point with a clinical trial involving 720 women that will finish recruiting patients next June and should report results in 2010.

Unlike the WHI study, women in the new trial -- the Kronos Early Estrogen Prevention Study, or KEEPS -- will be aged between 42 and 58. The average age in WHI was 63, which is 10 years after the average age for the onset of the menopause.

Although the science is still unclear, Miller believes it is likely that the oestrogen in HRT helps prevent the build-up of fatty plaque inside women's arteries when given early. If given late, when plaque is already established, it could cause it to break up, triggering blood vessel blockages and heart attacks.

''It may not benefit everybody but we think there is a group of women where you can intervene early to provide protection not only for cardiovascular but also other diseases of ageing, such as osteoporosis and cognitive function,'' Miller said.

REUTERS MS ND1026