06/05/2002 By David Loshak
Women who live in countries with a relatively low incidence of ischaemic heart disease have a different risk/benefit ratio than in countries like the United States which has a higher incidence of heart disease.
This recommendation arises from a study which has highlighted differences in female mortality from ischaemic heart disease in Italy and the US. Specialists point out that although observational studies indicated that hormone replacement therapy could help to prevent cardiovascular disease, no randomised studies had confirmed this.
The say: “Once these studies do so, it will be mandatory to discern country-specific peculiarities regarding mortality and morbidity, before readily transferring any possible conclusions to other countries.
“It will still be important to take into account a different risk/benefit ratio for long-term hormone replacement therapy users in countries with an ischaemic heart disease incidence lower than that in the US”.
Observational studies had indicated that hormone replacement therapy reduced ischaemic heart disease mortality, but not stroke mortality.
It had also been widely recognised that there was a slight increase in breast cancer after five years of hormone replacement therapy.
This meant that the prescription of hormone replacement therapy in countries with a generally low ischaemic heart disease incidence rate might lead to a different risk/benefit balance for long-term hormone replacement therapy users.
In their study, the specialists considered female mortality due to ischaemic heart disease, cerebrovascular diseases, all malignant neoplasms and breast cancer in Italy and the US to detect any possible differences that could alter the hormone replacement therapy risk/benefit assessment.
They noted that while cardiovascular diseases were the leading cause of death in women aged 50 years and above in both Italy and the US, there were differences in mortality, particularly from ischaemic heart disease and cerebrovascular diseases.
Among Italian women aged 50 years and more, 12.6 percent of deaths were attributed to ischaemic heart disease and 14.6 percent to cerebrovascular diseases. Among American women aged 50 years and more, 19.4 percent of deaths were attributed to ischaemic heart disease and 8.1 percent to cerebrovascular diseases.
Also, ischaemic heart disease mortality in American women remained constantly higher than cerebrovascular diseases mortality at all ages.
In Italy, that applied only to women aged 50-79 years. The proportion of deaths due to ischaemic heart disease was always higher in the US than in Italy.
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