- Oestrogen
- Antioxidant vitamins
- Aspirin
Oestrogen
There is strong evidence that oestrogen replacement therapy (ORT) significantly reduces the risk of CHD in women (Stampfer, 1991). One study demonstrated a 60% reduction in mortality risk for CHD and a 73% reduction for other cardiovascular problems such as stroke (Ettinger, 1996). Some studies, however, have raised concerns about the long-term health impact of ORT on breast cancer (see page 29). A major review article argues that although the influence of ORT related to the development of breast cancer is not yet clear, any increase in risk is likely to be small (Rich-Edwards, 1995). Treatment often combines oestrogen and progesterone to reduce the risk of developing endometrial cancer. A major study suggests that oestrogen alone or combined with progesterone confers a protective benefit, particularly for women who are at high risk of CHD (Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial, 1995). Large-scale, long-term clinical trials in the United States, as part of the National Institutes of Health’s Women’s Health Initiative, are studying the risk/benefit and cost implications of widespread use of hormones, but results were not available at the time of publishing this report.
Antioxidant vitamins
Researchers are seeking the best ways to prevent blood vessels from deteriorating and clogging. One hypothesis is that heart attack rates may be reduced by a diet rich in fruit and vegetables foods high in carotenoids (compounds found in fruits and vegetables that convert to vitamin A in the body), and in vitamin C and vitamin E, also known as antioxidants. These vitamins are thought to prevent the oxidation of cholesterol in the blood, a process that produces the fatty deposits that stick to the walls of blood vessels and obstruct circulation. A study on male smokers, however, did not show such positive results for one of the best known of the carotenoids, beta carotene (Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group, 1994). Another study demonstrated positive links between high antioxidant intake and reduced risk of CHD (Morris, 1994). Protective effects may be associated with higher consumption of fruit and vegetables, which are rich in several carotenoids (Hankinson, 1994). Although the jury is still out on the benefits and risks of antioxidants, there is still hope that these compounds will help reduce CHD and other diseases.
Aspirin
Low-dose aspirin benefits men and women diagnosed with CHD, reducing the incidence of heart attack (Antiplatelet Trialists’ Collaboration, 1994: ISIS-2, 1988). Low doses of aspirin may help to prevent heart attacks in men who are at risk, although in may increase the risk of haemorrhagic stroke. Women may be at higher risk of stroke, and thus could not be presumed to derive the same benefit as men. Existing studies suggest a beneficial effect of low-dose aspirin (between one and six per week) for women at high risk of CHD, but evidence does not yet support preventive use of aspirin for asymptomatic women (Woods, 1994). Large-scale primary prevention trials are only now being conducted among women (Women’s Health Study Research Group, 1992).
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