Bioidentical Hormones - U.S. Senate Special Committee on Aging

6
with every stage of the disease: from the initiation, to the progression,
to the treatment of the complications-that is, people who
have already had heart attacks.
Statins are effective at every stage, OK? So, therefore, one can
assume that if you start statins at a young age and continue them
lifelong, they will continue to have benefit., That is an assumption
because that trial is not feasible, as it is also not feasible to do a
really long-term lifelong trial of hormone therapy.
So statins represent a favorable or an acceptable prevention
strategy. There are no known long-term complications.
The situation is different with estrogens, be they Premarin, conjugated
estrogens or estradiol.
There is increasing evidence that estrogens, generally, may retard
the earliest stages, the initiation, of atherosclerosis. There will
be more evidence in the next coming years that may or may not
be consistent with that idea. But at the moment there is reasonably
good evidence that that is the case, including from the Women's
Health Initiative, the recent publication.
However, once there are established raised lesions,- established
atherosclerosis, there is good evidence that estrogen in any form,
be it conjugated estrogens or estradiol, does not prevent further
progression. There is also good evidence that once there are complicated
lesions, estrogens actually trigger events and make matters
worse.
So estrogens do not represent a good prevention strategy. We
cannot assume that if you start it early, and there is potential benefit,
that that benefit will persist into older age.
Again, that is an assumption. We cannot do that trial. But knowing
what we know, that would be a very far stretch of the imagination
to imagine that if you start it early and use the right estrogen,
you will get a different outcome than we found in the Women's
Health Initiative.
So, again, we don't think that there is any essential difference
between estradiol and conjugated equine estrogen as far as heart
disease is concerned. We don't believe that this window of opportunity
is anything but a window into the present. There is a reasonably
safe period to use hormone therapy close to the menopause,
but it is not necessarily a window into the future if you
start then and persist that that benefit will persist.
With that, I will close and thank the committee for addressing
them on this very important issue to women's health. I am happy
to entertain questions.
[The prepared statement of Dr. Rossouw follows:]