Cardiovascular disease in women: the role of hormone replacement therapy

ABSTRACT

Cardiovascular disease [CVD] is the number one cause of death in women. Premenopausal women rarely get CVD unless they are diabetics, smokers, or have hereditary hypercoagulable states. However, after the menopause and with the loss of the protective estrogenic protection, incidence of CVD increases substantially. Epidemiological studies showed a cardiovascular benefit among hormone replacement therapy [HRT] users, but the bias in these uncontrolled studies may offset any firm conclusion on the role of HRT for CVD prevention. Randomized clinical HRT trials in primary and secondary cardiovascular prevention will be discussed including HERS I and II, WHI, WISDOM, ESPRIT, ERA, and KEEPS. Due to the lack of benefit of combined HRT in preventing CVD, emphasis is now shifting towards other options such as statins, and selective estrogen receptor modulators