Certain Painkillers May Negate Heart Benefits of HRT

By Amanda Gardner
HealthDay Reporter
Wednesday, May 23, 2007; 12:00 AM

WEDNESDAY, May 23 (HealthDay News) -- Women who take a certain type of nonsteroidal anti-inflammatory painkiller may cancel out any benefit their heart gets from also taking hormone replacement therapy, a new study suggests.

But the findings shouldn't cause women to change their medication practices -- at least not yet, the study authors emphasize.

"This isn't a message that women who happen to be taking hormone replacement therapy and NSAIDs [nonsteroidal anti-inflammatory drugs] are headed for disaster," said senior author Dr. Garret A. FitzGerald, a professor of medicine and pharmacology at the University of Pennsylvania Institute for Translational Medicine and Therapeutics. "This shouldn't be a basis for clinical judgment but a stimulus for people to actually do research and address the question more comprehensively."

The study, published this week in the journalPLoS Medicine, brings together two of the more controversial issues in medicine today.

Hormone replacement therapy (HRT) had long been thought to prevent heart disease in postmenopausal women. The results of the landmark Women's Health Initiative (WHI) study, however, seemed to prove that not to be the case.

However, a more recent sub-analysis of data from the WHI found that hormone replacement therapy may help protect the hearts of women who start taking the hormones closer to the time menopause starts.

"The whole issue of whether there is a protective effect has been World War III," FitzGerald said. "But a recent paper suggested that what really matters is when you start taking HRT."

Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City, added: "They (the researchers behind this week's study) studied two of the most controversial medications and studied them both together. It's a precocious study."

In the Women's Health Initiative study, a subgroup of NSAIDs known as cox-2 inhibitors were found toincreasethe risk of cardiovascular problems. As a result, the cox-2 inhibitors Vioxx and Bextra were withdrawn from the market.

When the cox-2 enzyme is inhibited, production of a molecule called prostacyclin is prevented. Prostacyclin, in turn, helps prevent blood clots. "The hazards of NSAIDs derive from their ability to inhibit cox-2-dependent prostacyclin," FitzGerald said.

The hormone estrogen acts to increase production of prostacyclin. This raises the possibility that lack of a heart-protective effect from estrogen may sometimes be due to the counter effect of a NSAID.

The researchers analyzed medical records for 1,673 British women aged 50 to 84 who had had heart attacks or who had died from coronary heart disease. These were compared with the medical records of 7,005 women who served as controls.

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