HORMONE REPLACEMENT THERAPY IN POSTMENOPAUSE ANDCARDIOVASCULAR DISEASES

Abstract

BACKGROUND Cardiovascular diseases are the leading cause of morbidity and mortality for adultwomen in developed countries. Several studies report the existence of a gender differencein the use of diagnostic and therapeutic procedures for cardiovascular diseases. Althoughmost risk factors contribute to cardiovascular diseases in both men and women, theimpact of individual risk factors might be different. The influence of menopause on bothcardiovascular risk factors and cardiovascular diseases is unique for women.Several large epidemiological studies have implicated the significant cardioprotective rolefrom hormone replacement therapy (HRT) in menopause. However, the two randomized,placebo controlled clinical trials did not confirm this protective effect from HRT in primarynor secondary coronary prevention. Similarly, no protection from HRT for stroke wasreported in three randomized placebo controlled trials. There are several explanations forthese unexpected results: hormone users in epidemiological trials could have less cardiovascular risk factors and could be more healthy than controls. On the other hand, only onetype of HRT was studied in randomized clinical trials, which included older patients, and42 % drop out was found in the active treatment group. Post-hoc analysis of the Women’s Health Initiative trial found a trend toward cardioprotective effects of HRT in youngergroup of patients. CONCLUSIONS Based on these data, International Menopause Society and North America MenopauseSociety stated that HRT is currently not recommended as a sole primary indication forcoronary prevention in women of any age. Initiation of HRT in women aged 50 to 59years or in those within 10 years of menopause to treat typical menopausal symptoms doesnot seem to increase cardiovascular events. There is emerging evidence that initiation ofHRT in early postmenopause may reduce cardiovascular risk