HRT may pose more harm than good
BY L.AURAN NEERGAARD 1
THE ASSOCIATED PRESS ,
I
WASHINGTON - Scien- ;
tists for the government ;
abruptly ended the nation's (
biggest study of a type of h'or- |
mone replacement therapy,
saying long-term use of estro- i
gen and progestin significant- (
lyr increases women's risk of t
breast cancer, strokes and .
heart attacks. j
; The hazards turned up dur
ing a study of more than
16,000 women at 40 medical .
centers, including 636 through j
the University of North Car- (
ofina at Chapel Hill. I
I Six million American i
Women use this hormone com
bination, either for short-term
relief of hot flashes and other
menopausal symptoms or
because of doctors' long
standing assumptions that
long-term use would preignt
heart disease and brittle bones
and generally keep women
healthier longer.
In fact, there are serious
risks to using the hormones
for years, risks that far out
weigh the few benefits, the
National Institutes of Health
announced last week.
The hormones harm, not
protect, the heart. They actual
y increase previously healthy
women's risk of a heart attack
jy 29 percent and a stroke by
i stunning 41 percent. They
ilso increase women's
.hances of breast cancer by 26
jercent.
On the good side, the hor
nones cut by a third the risk
)f colon cancer and hip frac
ures - but there are other,
.afer ways to fend off those
illnesses, doctors noted.
So the NIH stopped the
16,600-woman study three
years early and is advising
other women who use the
:strogen-progestin combina
tion to ask their doctors if
they, too, should quit.
"This clarifies the picture
and will affect the practice of
medicine," said Dr. Gerardo
Heiss. a professor of epidemi
ology at the UNO School of
Public Health and lead inves
tigator of the university's por
tion of the study.
"What this study clearly
establishes is that hormone
replacement therapy, as a
long-term preventive measure,
is not a viable option," he
said.
The NIH's Women's
Health Initiative sponsored
the study. "We want to get the
word out to women and their
doctors that long-term use of
this therapy could be harm
ful," said Dr. Jacques
Rossouw, acting director of
the initiative.
Women may still want to
use the hormones for a short
period to treat menopause
symptoms such as hot flashes,
he said. But for how long?
"There is no really safe
period," he acknowledged,
noting that the heart attack
risk hit during women's first
year taking the hormones, "as
short a period as you can get
away with in order to manage
the menopausal transition."
Other researchers were
even more negative.
"We recommend that clini
cians stop prescribing this
combination for long-term
use," wrote Dr. Suzanne
Fletcher of Harvard Medical
School in an editorial accom
panying the study results post
ed on the Web site of the Jour
nal of the American Medical
Association. "Risks from the
drug add up over time."
The study's leaders
stressed that women shouldn't
paniy because personal risk is
pretty small.
In one year, for every
10,000 women who take the
estrogen-progestin combina
' I
tion there will be eight more
breast cancers, eight more
strokes and seven more heart
attacks - and six fewer colon
cancers and five fewer hip
fractures - compared with
10.000 women who didn't
take the pills.
However, because millions
take the hormones, those num
bers can add up to thousands
of illnesses, Rossouw noted.
To use estrogen or not has
long been a vexing question
for women entering
menopause. While the study
seems definitive, it doesn't
settle all the questions:
? What about women who
use estrogen alone? The NIH
is letting a second, smaller
study of those women contin
ue for now, saying so far the
balance of risks and benefits
remains uncertain. Only
women who have had hys
terectomies can use estrogen
alone, because it causes uter
ine cancer unless balanced by
progestin.
? How do the risks stack up
for short-term use? In the lat
est study, the cardiovascular
risk actually jumped within
the first year of use while the
cancer risk didn't appear until
around year four.
"The message still goes
back to treat your individual
needs," said study co-author
Jennifer Hays of the Baylor
College of Medicine. "If you
can't sleep for three weeks
(because of night sweats) and
short-term therapy at a low
dose helps you with that, qual
ity of life is an important
thing."
? This study used Prempro.
the most popular estrogen
progestin combination. But
what about lower-dose pills or
even skin patches?
Without testing each, "you
can get wrong answers," cau
tioned study co-author Dr.
Norman Lasser of the Univer
sity of Medicine and Dentistry
of New Jersey, who wants
drug companies to do such
testing. "It's going to be a
while 'til we know what's
safe."
Wyeth Pharmaceuticals,
which makes Prempro and
other estrogen supplements,
said the main reason women
start hormone therapy is to
relieve hot flashes, night
sweats or vaginal problems.
"It is important to recog
nize the critical role" the hor
mones play for those women,
said Wyeth vice president Dr.
Victoria Kusiak.
File Photo
A study of more than 16,000 women at 40 medical centers indicates that long-term use of
estrogen and progestin significantly increases women's risk^of breast cancer, strokes and
heart attacks.
Diabetes
frttm page C3
energy more efficiently when
food was scarce but that today
may instead make the person
more susceptible to developing
type 2 diabetes.
? Gestational diabetes - in
which blood glucose values are
elevated above normal during
pregnancy - occurs in about 2 to 5
percent of all pregnant women.
Large body size and low blood
sugar are higher in these pregnan
cy ? but the women generally
return to normal glucose values
after childbirth. Once a woman
has had gestational diabetes, she
has greater risk of developing ges
tational diabetes in future preg
nancies. Also, about half the
women with gestational diabetes
develop type 2 diabetes within 20
years of the pregnancy. The occur
rence of gestational diabetes is 50
to 80 percent more frequent in
African-American women than in
white women, according to sever
al studies.
? Hyperinsulinemia - higher
thatl normal levels, of fasting
insulin - is associated with an
increased risk of developing type
2 diabetes, and studies have
showii higher insulin levels in
African Americans than in whites.
? Obesity is a major risk factor
for type 2 diabetes, and African
Americans have higher rates of
obesity than whites.
? Lack of regular physical
activity: In one survey. 67 percent
of African-American women and
50 percent of African-American
meit reported that they participat
ed iO little or no leisure time phys
ical activity.
? Other factors yet to be under
stood.
According to NDIC, African
American children seem to have
lower rates of type 1 diabetes than
white children, but the prevalence
of type 2 diabetes has been
increasing in children, especially
among African-American, Ameri
can-Indian and Hispanic children.
The frequency of diabetic
retinopathy - a deterioration of the
blood vessels in the eye that is
caused by high blood glucose and
can lead to impaired vision and
blindness - is 40 to 50 percent
higher in African Americans than
in whites, according to NDIC.
African Americans with diabetes
experience kidney failure about
four times more often than whites.
African Americans with diabetes
are much more likely to undergo a
lower-extremity amputation than
whites. According to one study,
the death rate for people with dia
betes was 20 percent higher for
African-American men and 40
percent higher for African-Ameri
can women, compared with
whites.
In 1996. NIDDK began a
research effort to learn how to
prevent or delay type 2 diabetes in
people with impaired glucose tol
erance, a strong risk factor for
type 2 diabetes. The findings,
released in August 2001, showed
that people at high risk for type 2
diabetes could sharply lower their
chances of developing the disease
through healthful eating and regu
lar physical exercise. In addition,
treatment with the oral diabetes
drag metformin reduced diabetes
risk, but less dramatically. Study
participants who made lifestyle
changes (including getting 30
minutes of exercise per day such
as walking or other moderate
exercise) lost 5 to 7 percent of
their body weight and reduced
their risk of getting type 2 diabetes
by 58 percent. Participants who
took metformin reduced their risk
of getting type 2 diabetes by 31
percent.
Mike Conrad, executive direc
tor of the Piedmont Triad Chapter
of the Juvenile Diabetes Research
Foundation, said his organiza
tion's mission is to find a cure for
diabetes and its complications
through research. He said his
organization does not keep statis
tics about the incidence of juve
nile diabetes among different
racial groups.
According to the organiza
tion's Web site, diabetes kills one
American every three minutes; 16
million Americans have the dis
ease, and of these 5.4 million
remain undiagnosed. Worldwide,
diabetes afflicts 120 million to
140 million people, and that num
ber is expected to more than dou
ble by 2025. More than 1 million
Americans have Type 1 (juvenile)
diabetes.
Conrad said the Piedmont
Triad Chapter of the Juvenile Dia
betes Research Foundation will
have four walks (called Walk to
Cure Diabetes) to raise money for
diabetes research: Sept. 7 at High
Point Central High School. Sept.
21 at Davis Field at Wake Forest
University. Sept. 28 at Grimsley
High School in Greensboro and
Oct. 19 at Elon University in Ala
mance County.
All the walks will begin at 8
a.m. For information, call 768
1027.
DEET
from page C3
offered complete protection for
an average of almost two hours.
?Bite Blocker for Kids, in which
the active ingredient is 2 percent
soybean oil. lasted an hour and a
half on average, he said.
Various Skin-So-Soft prod
ucts, ^including those containing
eithet the chemical 1R3535 or
plant-based citronella protected,
on average, far less than 20 min
utes. Recently introduced oil of
eucalyptus repellents Fite Bite
and Repel lasted an average of
two hours.
"If you are outside at a bar
becue in the United States, this
variability probably won't make
much difference." Fradin said.
"But if you are looking for pro
longed protection that's reliable,
especially in tropical and sub
tropica! countries where mosqui
to-bome diseases are endemic,
then your best bet would be to
choose products containing
DEET."
Worldwide, mosquitoes
transmit diseases to 700 million
people a year, he said. Malaria
alone still kills up to 3 million
people annually. Even in the
United States, various forms of
mosquito-borne encephalitis
show up from time to time, and
West Nile virus, which has been
detected to date in 27 states,
killed seven people in the New
York City area two years ago.
DEET's toxicity gets a lot of
news media attention every year,
but the UNC dermatologist said
concerns about that appear to be
grossly exaggerated. The "very
safe" product has been on the
market for some 45 years, and
fewer than 50 cases of signifi
cant toxicity have been reported
in the medical literature.
"In many of those cases,
there was excessive, very inap
propriate use of a DEET product
in which someone was applying
a high-strength formulation and
covering large areas of skin for
many days in a row," Fradin
said.
Estimates are that DEET
based products have been used
between 5 billion and 8 billion
times with very few reported
problems, he said.
"Until a better repellent
becomes available. DEET-based
repellents remairt the gold stan
dard of protection under circum
stances in which it is crucial to
be protected against arthropod
bites that might transmit dis
ease," Fradin said.
The state of Florida paid for
part of the study, which received
no support from industry, he
said.
Commission
* fmm pane C3 '
the national average. With this
commitment of fiinds, North
Carolina is taking a major step
in reducing the rate of teen
smoking. Clearly, we must do
what we can to prevent teens
from smoking and help them
quit if they have already begun.
Last month, spurred by the
actions of the Health Trust I
took my personal and profes
sional corpmitment to teen
smoking prevention one step
further by authoring a State
Board of Education resolution
calling for local school boards
to adopt a tobacco-free policy
that prohibits tobacco use for
students, staff and visitors on
school property during opera
tional hours in their local educa
tional agency.
Thus in the span of about
one year, the Health Trust has
crafted two significant plans
with a positive long-term
health-care impact. The Health
Trust passed these programs
after serious deliberation and
public input. Moreover, we
have balanced the need to create
effective programs generating
long-term benefits within limit
ed funding. I firmly believe this
commission has given the peo
ple of North Carolina a tremen
dous health-care bang for their
buck.
The Health Trust is made up
of dedicated, knowledgeable
leaders representing many
facets of the health-care arena.
Our monthly meetings are open
and all policy decisions are
made in the light of day. Work
ing within our given resources,
we continue our goal'of maxi
mizing the public health benefit
for North Carolinians.
In 1998, the General Assem
bly made a farsighted decision
to allocate a portion of the
tobacco settlement money
toward health and wellness pro
grams. It was the right thing to
do. The funds allocated to the
Health and Wellness Trust Fund
Commission from the settle
ment have been used prudently
and reasonably on clearly
deftned programs that target at
risk segments of our population.
With vision, leadership and
clarity of purpose, the Health
Trust will continue to make a
positive impact on the quality of
life for Tar Heels for genera
tions to come.
Agency
from page C3
Harper and his wife, Annette,
have three children, Erin. 19, a
sophomore at High Point Uni
versity; Meredith. 14. a fresh
man at Western Guilford High
School; and Adam, 6, a first
grader at Claxton Elementary
School in Greensboro.
"Many people know the
March of Dimes succeeded in its
initial mission to find a cure for
polio. Now we have as our mis
sion to improve the health of
babies by preventing birth
defects and infant mortality,"
Harper said. "I feel- that every
baby born deserves the same
opportunities, the same start in
life. We here at the March of
Dimes are dedicated and com- i
mined to research and education
that will help in assuring healthy
births."
Harper remains active in the
Boy Scouts by volunteering with
the Old North State Council of
Boy Scouts of America and
holds volunteer positions at
Muirs Chapel United Methodist
Church in Greensboro.
Upcoming March of Dimes
events include the N.C. Chili
Championship & Rubber Duck
Regatta on Sept. 21 at Tangle
wood Park, Bikers for Babies
Oct. 19 in Winston-Salem and
the Gourmet Chefs' Auction
Nov. 9 at the Greensboro Chil
dren's Museum. More informa
tion is available on the March of
Dimes Web sites at www.mar
ehofdimes.com and www.nacer
sano.org.
-Si
^ .o
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1-1?
5 "8 o
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