Estrogens also appear to have a positive effect on blood vessels throughout the body. In addition, estrogen appears to decrease fibrinogen levels, which cause the blood to become thicker. Higher fibrinogen levels are associated with higher levels of heart disease.

Are You At High Risk For Heart Disease ?

Even after a woman has proven heart disease that shows up on a coronary arteriogram, some studies have shown that estrogen is beneficial.

However, in spite of strong evidence suggesting that estrogen by itself reduces heart disease, experts Dr. Elizabeth Barrett-Connor and Dr. Trudy Bush recommend prescribing estrogen only to women who are at high risk for heart attacks until there are proper studies completed that support the widespread use of this drug for disease prevention (Journal of the American Medical Association, Apr 10/91).

Women with the following risk factors may be at high risk for heart attacks:

1. Already proven hardening of the arteries of the heart (arteriosclerosis).

2. Both ovaries removed.

3. Cigarette smoking.

4. High blood pressure.

5. High cholesterol or triglycerides.

6. Diabetes or pre-diabetes.

Most of these risk factors can be substantially altered through lifestyle and dietary changes. Dr. Dean Ornish has written a comprehensive book outlining one such program entitled, DR. DEAN ORNISH'S PROGRAM FOR REVERSING HEART DISEASE (Random House, 1990).

Interestingly enough, when Meir Stampfer, Associate Professor of Epidemiology at the Harvard School of Public Health, analyzed the Nurses' Study, he found that those who took 100IU or greater of vitamin-E for 2 years or longer, had sixty percent less risk of major heart disease. However, in the case of an inexpensive vitamin with few side effects, this is not considered good enough evidence. Stampfer maintains that public policy recommendations should await randomized trials. However, at a recent meeting in Toronto, he did allow that it was "not unreasonable" to take vitamin E to prevent heart disease.

Hormones And The Heart: The Cons

Dr. Prior points out that the approval of menopausal hormone therapy as a drug for the prevention of heart disease is premature. No other heart drug (for example like a new beta blocker) would be approved based on the quality of evidence now available.

The present evidence, Prior says, is based on cross sectional, cohort and prospective studies. The largest of these was the Nurses' Study, began in 1976, which sent out thousands of questionnaires, including, among others, a question about whether the women were taking estrogen. The questionnaires were sent out every two years, with a ten year follow up to date.

The results showed that women taking estrogen had 50 percent fewer heart attacks. However, the nurses taking estrogen were healthier, had a higher economic or educational status, exercised more and smoked less, and were also less likely to suffer from hypertension, diabetes, or obesity.

Dr. Stampfer's sub-analysis of the nurse's study using data from healthy low risk women, found that estrogen users still showed a fifty per cent reduction in heart disease.

Nonetheless, Prior maintains that without a proper double blind controlled study, accurate estimates of the heart attack risk for estrogen users cannot be made.