Hormone replacement therapy and cardiovascular risk

We are reexamining the role of hormone replacement therapy in cardiovascular risk in light of the results from the Heart and Estrogen/Progestin Replacement Study (HERS) trial. Prior to this trial, the wealth of evidence in the laboratory and in observational trials suggested that estrogen replacement was associated with significant cardioprotection. The HERS trial was the first randomized trial of this therapy in postmenopausal women with coronary artery disease, and it did not demonstrate a reduction in cardiovascular events in women taking hormone replacement therapy. These findings have made us rethink some of the basic science underlying the cardiovascular effects of hormone replacement therapy. Recent evidence regarding thromboembolic risk, inflammation, and types of hormone replacement therapy is discussed.