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Menopausal hormone therapy and cardiovascular risk

Authors
Kathryn A Martin, MD
Robert S Rosenson, MD
Section Editors
Peter J Snyder, MD
Robert L Barbieri, MD
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Kathryn A Martin, MD

INTRODUCTION

The net benefit of estrogen or combined estrogen-progestin therapy in postmenopausal women is still uncertain. Based upon extensive observational data, it was believed that estrogen was cardioprotective; as a result, estrogen therapy was routinely prescribed for both primary and secondary prevention of coronary heart disease (CHD). (See "Menopausal hormone therapy: Benefits and risks".)

However, data from the Heart and Estrogen/Progestin Replacement Study (HERS-I and -II), other small controlled trials, and several meta-analyses, did not confirm a protective effect on the heart [1-14], and the Women's Health Initiative (WHI) combined estrogen-progestin trial reported an increase in CHD risk [15]. The WHI unopposed estrogen trial did not report an increase in CHD events, although stroke and venous thromboembolism (VTE) were increased as was seen in the combined estrogen-progestin trial [16,17]. However, follow-up analysis suggests that younger women taking menopausal hormone therapy (MHT) (unopposed or combined) are not at increased risk for CHD [18].

Most now agree that estrogen is still a reasonable therapy when used short-term for menopausal symptoms, but it should not be prescribed for either primary or secondary prevention of CHD. (See "Treatment of menopausal symptoms with hormone therapy".)

The impact of estrogen therapy on cardiovascular risk will be reviewed here. The discussion will include both cardiovascular outcomes and the effect of estrogen therapy on serum lipid values, blood pressure, and body weight. Other aspects of estrogen therapy are reviewed in detail elsewhere. (See "Menopausal hormone therapy: Benefits and risks" and "Postmenopausal hormone therapy in the prevention and treatment of osteoporosis" and "Menopausal hormone therapy and the risk of breast cancer".)

CORONARY HEART DISEASE

Although initial observational studies suggested benefit from menopausal hormone therapy (MHT) for both primary and secondary prevention of coronary heart disease (CHD), this has not been confirmed in subsequent large trials. Factors including the older age and greater weight of the WHI population, as well as the estrogen type, route of administration, and dose may play a role [19].

                                  

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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 21 00:00:00 GMT+00:00 2015.
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