In 2002, researchers published the results of the Women’s Health Initiative, a massive clinical trial designed to investigate the effects of menopausal hormone therapy (MHT) on postmenopausal women. The study claimed that hormone replacement therapy significantly increased the risk of breast cancer and blood clots in participants. The risk was so great, in fact, that they ended the study prematurely.
Of course, the media jumped all over this, following the common news mantra “if it bleeds, it leads.” Major outlets ran alarming headlines before the full data was released to the scientific community. Moreover, they tended to focus on relative risk—the study showed a 26 percent increase in breast cancer, for instance—rather than absolute risk—one additional case per 1,000 women per year.
What the media didn’t report was that the study had several critical flaws, including that it used synthetic rather than bioidentical hormones, and many of the reported risks were not actually statistically significant.
But because of the media headlines following the WHI study, 80 percent of doctors today still refuse to prescribe hormones. This, according to Randy Vawdrey, NP-C, has inappropriately denied 50 million women a therapy that could have greatly helped both their lifespan and healthspan.
DHEA’s Protective Role in Heart Health
Take dehydroepiandrosterone (DHEA), for example. DHEA is the body's most abundant steroid hormone. While it’s primarily an adrenal hormone, it also plays a role in estrogen and testosterone creation. And, like many of your body’s functions, DHEA production slows as you age.
This is an unfortunate reality. DHEA plays a protective role against any number of ailments. For one, it protects the heart and vascular system:
- It raises nitric oxide levels, which helps blood vessels dilate, improving blood flow and reducing blood pressure.
- It helps shield against atherogenesis (the formation of plaque in the arteries)
- It acts as a powerful anti-inflammatory agent and antioxidant.
And the research consistently shows that higher levels of DHEA correlate with better cardiovascular outcomes in both women and men. One study of post-menopausal women, called the WISE Trial, found an inverse relationship between DHEA levels and heart disease. And the Massachusetts Male Aging Study showed that low DHEA levels in men predicted coronary artery disease independently of other major risk factors like smoking, obesity, diabetes, and high blood pressure.
Levels of DHEA naturally decline after the age of 30, and the body does not have a mechanism to restart production once it slows down. Given the protective benefits of DHEA, hormone therapy seems like a natural solution to address this decline.
Randy Vawdrey has found this to be the case not just in theory but in practice. When he prescribes low-DHEA patients with oral DHEA, they often come back feeling much better than before beginning treatment. The key, he says, is to prescribe the right dosage. He’s found that smaller doses (5–10 mg) don’t actually raise DHEA levels in the blood. He typically starts patients at 50 mg, monitoring and adjusting as needed to ensure progress.
Most practitioners complete their clinical training without learning how to screen for coronary artery calcium, interpret white matter disease on brain MRI as hypertensive injury, or recognize when poor dental health is driving systemic inflammation high enough to trigger cardiac events.
The consequence? Preventable cardiovascular events occur because the screening, assessment, and risk stratification protocols taught in medical school are incomplete.
You cannot prevent disease you do not detect. In the Kharrazian Institute’s latest Master Class, “Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction,” Randy Vawdrey, NP-C, shows you how to move beyond cholesterol obsession toward comprehensive cardiovascular risk reduction. The class integrates conventional and functional medicine approaches, combining blood pressure targets, pharmaceutical options, and nutraceutical protocols into decision trees you can implement in your practice today.
Menopausal Hormone Therapy, Heart Health, and More
DHEA isn’t the only hormone to be aware of when it comes to hormone therapy. The upside of DHEA treatment is that it works for both men and women, meaning any of your patients over 30 could benefit from it.
But specifically for women, menopausal hormone therapy is a treatment you should be considering, if not already providing, in your clinical practice—for several reasons.
First, MHT can be an integral part of a cardiovascular prevention program. For example, the rates of heart disease in menopausal women match those of men. Women seem to be protected from cardiovascular disease when they're menstruating, but once they lose the hormone stimulus that accompanies menstruation, the heart-protective benefits decline. MHT can help rebalance and restore lost hormones, resulting in better vascular health, lower blood pressure, and a 50 percent lower risk of heart attacks.
But, says Randy, the benefits of MHT go further than heart health: It actually changes lives. He’s seen the evidence in his own patients:
- It helps women sleep better.
- It reduces the risk of osteoporosis.
- It helps to protect their brains.
- Their moods improve.
- They don't need as many antidepressants or anti-anxiety medications.
- Their sex life gets better.
Not to be outdone, MHT is also a critical component of "preventive neurology.” Studies indicate that women who start hormone therapy may experience 50–60 percent less cognitive decline. Research has also revealed that patients on optimized hormone protocols have a 35 percent lower risk of Alzheimer’s disease.
Ultimately, Vawdrey contends that with the exception of antibiotics, no medication has the capacity to improve patient health more than MHT.
Thirty-one percent of Americans die from a heart attack, with 50 percent experiencing it as their first cardiovascular symptom. Yet many of these events are detectable and preventable—if you know where to look.
In “Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction,” Randy Vawdrey, NP-C, you’ll learn actionable protocols for cardiovascular risk reduction, such as how to:
- Interpret advanced lipid markers like ApoB and lipoprotein(a)
- Screen patients for sleep apnea using a single physical exam finding
- Recognize dental pathology that drives systemic inflammation
- Assess dysautonomia as an independent cardiovascular risk factor
- Optimize hormone status for cardioprotection
- Use CAC scoring to measure prevention progress objectively, and more.
Click here to enroll and start transforming your practice today.
Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction with Randy Vawdrey, NP-C
Hormones are essential for heart health, especially for women during and after menopause. While the WHI study effectively scared off a generation of medical professionals from prescribing menopausal hormone therapy, hormones like DHEA could be a critical missing link for cardioprotective care in your practice.
Randy Vawdrey, NP-C, is on a mission to change how modern medicine views cardioprotective care, moving from treating symptoms to preventing heart attacks before they occur. In our latest KI Master Class, Vawdrey distills 15 clinical modules into a comprehensive prevention strategy that addresses the actual drivers of cardiovascular disease—not just LDL numbers.
You will learn how to screen for silent neurological damage from hypertension, identify clotting risks before they become events, optimize hormone status for cardioprotection, and use advanced markers like coronary artery calcium scoring to predict risk 10 times better than traditional lipid panels.
When you take this course, you will leave with evidence-based protocols that combine conventional and integrative strategies proven to reduce all-cause cardiovascular mortality.
Randy Vawdrey is the former Program Director for Portneuf Valley Hospital’s Gerontological Psychiatric Hospital. He has completed an advanced pharmaceutical certification at McLean Hospital and served as the Director of the Psychotropic Drug Review at the Idaho State Veterans’ Home. He is currently CEO/NP-C at Physicians Immediate Care and Physicians Optimal Health and Medical Director of A Mind For All Seasons. Randy graduated in 1998 from BYU with a degree in nursing.
Frequently Asked Questions
What is an effective clinical starting dose for DHEA supplementation?
In clinical practice, low doses (5–10 mg) are often insufficient to raise levels. A more effective approach is to start patients on 50 mg of oral DHEA, followed by regular lab monitoring to adjust the dosage to their specific needs.
How does menopausal hormone therapy (MHT) provide cardioprotection for women?
During their childbearing years, women enjoy a natural protection against heart disease due to the hormonal shifts of menstruation. When menopause occurs, this protective stimulus disappears, and women's cardiovascular risks rapidly match those of men. MHT helps restore this hormonal baseline and can lower the risk of heart attacks by up to 50 percent.
How can I safely integrate hormone optimization and advanced cardiac screening into my current protocols?
Standard medical training often leaves significant gaps in early disease detection, leaving practitioners dependent on basic cholesterol markers while missing silent drivers like systemic inflammation, vascular damage, and hormonal decline.
To master these advanced strategies, enroll in the Kharrazian Institute’s Master Class, “Preventive Cardiology: Comprehensive & Integrative CV Risk Reduction,” taught by Randy Vawdrey, NP-C. This clinical program translates complex cardiovascular science into actionable decision trees, combining advanced lipid markers, functional metrics, and practical hormone protocols you can implement in your practice immediately.
Click here to learn more and register for the Master Class today.
