Elsevier

Maturitas

Volume 54, Issue 4, 20 July 2006, Pages 372-379
Maturitas

Postmenopausal hormone therapy and cardiovascular disease: An overview of main findings

https://doi.org/10.1016/j.maturitas.2006.04.019Get rights and content

Abstract

Cardiovascular disease has emerged as a leading cause of death in women. In recent years, significant attention has been paid to the potential benefits of hormone therapy on chronic diseases such as cardiovascular disease. Large prevention trials failed to confirm the cardioprotective effect of estrogen. The divergent findings from observational and randomized clinical studies are summarized and reasons for the different results are postulated. Use of estrogen alone or estrogen opposed with progestins is not indicated for the prevention of cardiovascular disease and may even increase the risk of stroke. Oral estrogen increases venous thromboembolism events. Recent data suggest that transdermal estrogens are safe with respect to venous thromboembolism. Current data have limited ability to investigate the wide variety of hormone treatments available. Clinical research should be continued to assist patients and clinicians in making treatment decisions on the basis of an individual's benefits and risks.

Section snippets

HT and CHD

The view that HT was considered an effective method to protect postmenopausal women from CHD has been supported by a substantial number of basic science and observational studies. However, recent trials which tested the effect of HT on CHD, failed to confirm this hypothesis.

Observational studies: quantitative overview

Oral estrogen increases VTE risk. This relationship was initially established on the basis of studies of oral contraceptives and was not supported by studies of postmenopausal estrogen replacement. The findings of recent studies of HT differ from studies published earlier that showed no association with VTE. Current data show that HT is associated with a two-to three-fold increased risk of VTE [4]. This risk is higher within the first year of treatment. There is no convincing evidence for a

Conclusion

HT offers well-established clinical benefit for menopausal symptoms but it should not be initiated or continued for the purpose of preventing cardiovascular disease. Certainly, a healthy lifestyle and a good medical care are the basis for preventing cardiovascular disease in postmenopausal women.

Existing trials have limited ability to investigate the wide variety of hormone treatments available notably the transdermal route of estrogen administration and progesterone. In addition, it is quite

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