[Secondary and tertiary prevention of atherosclerotic vessel disease]

A first randomized, prospective, placebo-controlled, blind study--the so called HERS-Study--was designed to demonstrate that continuously combined application of 0.625 mg conjugated estrogens and 2.5 mg medroxyprogesterone acetate is a suitable treatment regimen in secondary and tertiary prevention of coronary artery atherosclerotic disease. After a 4.1 years duration of treatment no essential differences in the occurrence of reinfaction, other complications due to atherosclerotic alterations, and survival rates between verum and placebo groups could be evaluated. Unanswered ist, whether the duration of treatment was sufficiently long, the dose of estrogens high enough, or whether the mechanism of estrogen action is antagonized at least in part by continuously administered medoxyprogesterone acetate. Several other questions remain open due to scanty informations on LDL-concentrations, and a complete lack of data concerning insulin/insulin resistance, hyperglycemia, respectively. Better results may be obtained with sequential estrogen/progestin treatment regimes or with estrogens only, progestins added on demand. Remaining additional risk factors have to be treated. Life style and nutritional habits should be adapted to atherosclerosis.