Hormone Replacement Therapy for Women for a Healthy Heart: Timing Counts

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Functional Medicine Specialist Dr. Marsha Nunley with H.E.A.L. Medical Provides Tips for Maintaining a Healthy Heart

Dr. Marsha Nunley

Now we've learned from new research that women within six years of the onset of menopause can slow the progression of cardiovascular disease with hormone replacement therapy.

Senior citizens are the fastest growing segment of the population. The number of people over the age of 65 is projected to double from 2012 to 2050, from 43 million to over 83 million. And while we treasure the wisdom that comes with age, it is a public health challenge as well as an individual one to keep the mind and body functioning as well as possible for as long as possible. The highest priority for an aging population is the cardiovascular system – the heart and blood vessels that pump and deliver blood to all parts of the body including the brain. The CDC confirms that heart disease is the leading cause of death for women in the United States, killing 292,188 women in 2009—that’s 1 in every 4 female deaths. “Changes to the heart and blood vessels occur with aging,“ says functional medicine specialist Dr. Marsha Nunley, founder of H.E.A.L. Medical, but many are preventable and treatable, improving overall health and prolonging life. Now we've learned from new research that women within six years of the onset of menopause can slow the progression of cardiovascular disease with hormone replacement therapy1.”

As we age, the heart rate slows slightly; the arteries thicken, stiffen and become less flexible (arteriosclerosis), causing the heart to work harder. The poor American diet with its emphasis on sugars and trans fats leads to elevated plaque that builds up on the artery walls (atherosclerosis), impeding blood flow. These changes may cause an increase in blood pressure, abnormal heart rhythms, coronary artery disease, cerebrovascular disease (stroke) and a number of other problems common in the elderly. “We can reduce the effects of these changes and the risk of vascular disease with lifestyle modifications,” says Dr. Nunley. Her recommendations are:

  • Eat a heart-healthy diet, mostly plants and maintain a normal weight.
  • Don't smoke.
  • Exercise regularly.
  • Get plenty of sleep.
  • Schedule preventative annual checkups and follow treatment regimens if necessary.

To these recommendations, Dr. Nunley adds an important additional consideration: hormone replacement therapy. Hormones are powerful and vital chemical messengers that signal cells throughout the body to perform their assigned tasks. Hormones regulate growth and metabolism, control immune function and reproduction, and influence emotions and mood. “Hormones also play a role in aging,” says Dr. Nunley. “As we age, not only does the amount of hormones we produce decline but some organs become less sensitive to the triggering action of hormones. Replenishing hormones that the body no longer produces on its own can help many people manage the effects of the aging process and reduce the risks of disease.”

In particular, it has long been known that hormone replacement therapy can have beneficial cardiovascular effects for post-menopausal women. Now a recent study at the University of Southern California confirms those benefits and supports the “timing hypothesis” – that there is a six-year window of opportunity after menopause beyond which cardiovascular benefits are not observed. Known as the “ELITE” trial (Early vs. Late Intervention Trial with Estradiol) and funded by the National Institutes of Health, the study tracked women who were within six years of the onset of menopause and those who were more than ten years beyond menopause. In a randomized trial, women were either given estradiol, a form of estrogen, the female sex hormone produced by the ovaries, or a placebo. After five years, the younger women who had taken estradiol showed less build-up of plaque in the arteries than those who had taken the placebo but the benefit was not seen in the older women.

“The buildup of plaque in the arteries is a leading indicator for heart disease and stroke,” says Dr. Nunley. “Evidence that the process can be slowed with timely intervention is an important advance in improving cardiovascular health for women. But it is important to start hormone replacement therapy early – within six years of menopause. Waiting longer may make it impossible to forestall the natural effects of aging.”

1. Howard N. Hodis, et al. Vascular Effects of Early versus Late Postmenopausal Treatment with Estradiol. New England Journal of Medicine, 2016; 374 (13): 1221 DOI:10.1056/NEJMoa1505241

Marsha Nunley, M.D., founder of H.E.A.L. Medical is board-certified in internal medicine, geriatric medicine, and palliative care. Dr. Nunley specializes in functional medicine, a systems-based approach to treating the whole person. http://www.marshanunleymd.com

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