[Cardiovascular risk and hormone replacement therapy in menopause]

Area of Science:

• Cardiovascular epidemiology
• Hormone therapy research
• Clinical trial analysis

Context:

• Cardiovascular risk associated with hormone replacement therapy (HRT) varies by vessel type and location.
• Previous meta-analyses indicated HRT reduces ischemic heart disease and cardiovascular mortality.
• Recent studies highlight increased cerebrovascular risk, specifically ischemic stroke.

Purpose:

• To analyze the cardiovascular risk associated with different types of hormone replacement therapy (HRT).
• To synthesize findings on HRT's impact on ischemic heart disease, cardiovascular mortality, and stroke.
• To evaluate recent clinical trial data on HRT and cardiovascular outcomes.

Summary:

• HRT shows a 30-50% decrease in ischemic heart disease and a 25% decrease in cardiovascular mortality.
• HRT is associated with a 20% increase in ischemic stroke but a 30% protective effect in hemorrhagic stroke.
• A trial of oral conjugated equine estrogen plus medroxyprogesterone acetate showed no reduction in myocardial infarction or cardiovascular death and increased thromboembolic events.

Impact:

• Findings underscore the complex and site-specific effects of HRT on cardiovascular health.
• Highlights the need for further research on HRT formulations, particularly those used outside Anglo-Saxon countries.
• Emphasizes the unknown cardiovascular effects of transdermal estrogen with natural progesterone, commonly used in France.