Once a heart attack has been diagnosed, treatment is generally the same for both men and women. It is important that treatment be sought as quickly as possible. Rapid treatment can reduce the muscle damage associated with a heart attack. 

For both women and men, the best strategy for preventing heart attacks is to make lifestyle changes that help prevent the main cause of heart attacks: coronary artery disease.

Earlier studies suggested that hormone replacement therapy (HRT) provided an added benefit in postmenopausal women by protecting them against heart disease. Current research has found differently. HRT involves the replacement of estrogen that is lost during menopause. Because natural estrogen protects younger women from heart disease, it was assumed that HRT could also help protect post-menopausal women from heart disease.

A pair of major studies was launched to study the effects of estrogen on heart disease in women. Known as the Women’s Health Initiative (WHI), these two studies did not measure the effect of estrogen on side effects of menopause. Instead, they considered only estrogen’s effect on the cardiovascular system. The first of the two studies looked at combination estrogen/progestin therapy in 16,000 postmenopausal women aged 50 to 70 who still had their uteruses. The second looked at estrogen-only therapy in 11,000 women who had no uteruses (and therefore did not need to take progestin).

Begun in 1997, the estrogen/progestin arm of the study was terminated on May 31, 2002, (three years before scheduled) when it was shown that the risks of estrogen/progestin outweighed its benefits. Researchers found that estrogen/progestin therapy increased the risks of heart attack, stroke, breast cancer, blood clots and overall cardiovascular disease. These findings overwhelmed the therapy’s mild protective effect against fractures and colon cancer. A separate study conducted by British researchers supported these results, adding that, for women in their 50s taking HRT for five years, breast cancer is the greater risk. Those in their 60s have a higher risk of stroke or pulmonary embolism.

The second part of the study, the estrogen-only portion, was discontinued in 2004 for similar reasons. Researchers found that the benefits of estrogen in these women were evenly balanced against its negative effects. Though estrogen-only HRT did protect against fracture and colon cancer, there was a significant increase in the rate of stroke and blood clots. However, there was no statistically significant increase in breast cancer rates.

The reaction to this news was rapid and widespread. Between 1995 and 2001, the percentage of women aged 50 to 74 taking some form of HRT increased from 33 percent to 42 percent. By 2003, after the first of these results had been published, that number dropped to 28 percent. Overall, hormone therapy prescriptions dropped 38 percent in the first year after the study’s findings were published. Today, neither estrogen/progestin therapy nor estrogen-only therapy are recommended for the prevention of heart disease, osteoporosis or Alzheimer’s disease.

It is important to note, however, that although these figures sound intimidating, they were derived from a large sample. In absolute terms, the level of increased risk to any individual woman on HRT is small. According to WHI researchers, the absolute risk of breast cancer or a cardiovascular complication from combination estrogen/progestin therapy is very low (about 19 events per 10,000 women). It is lower still for younger, postmenopausal women.

Indeed, the U.S. Food and Drug Administration (FDA) recognizes that women may still want to use HRT for a variety of menopausal and postmenopausal symptoms. Consultation with one’s physician is essential to weigh the family and person medical history, as well as potential risks and benefits with HRT over the short and long term.