Postmenopausal hormone replacement therapy as antiatherosclerotic therapy
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Published on: August 13, 2019
Howard N Hodis1, Wendy J Mack, Roger Lobo
1Atherosclerosis Research Unit, University of Southern California School of Medicine, 2250 Alcazar Street, CSC 132, Los Angeles, CA 90033, USA.
Insights
Postmenopausal hormone replacement therapy may reduce cardiovascular risk in women, but recent trials show mixed results. Further research is needed to confirm its broad effectiveness in preventing heart disease.
Area of Science:
- Cardiovascular Medicine
- Endocrinology
- Women's Health
Background:
- Cardiovascular disease is the leading cause of death in women.
- Lipid alteration alone may not be sufficient for optimal cardiovascular risk reduction.
- Postmenopausal hormone replacement therapy (HRT) is a potential strategy for reducing cardiovascular risk.
Purpose of the Study:
- To review the evidence on postmenopausal hormone replacement therapy and cardiovascular disease in women.
- To evaluate the impact of HRT on atherosclerosis and cardiovascular events.
- To reconcile conflicting results from observational studies and randomized controlled trials.
Main Methods:
- Review of observational studies on postmenopausal HRT use.
- Analysis of recently reported randomized controlled trials (RCTs) of HRT.
- Comparison of HRT effects versus placebo in cardiovascular outcomes.
Main Results:
- Over 50 observational studies suggest HRT reduces atherosclerosis and cardiovascular events.
- Recent randomized controlled trials have produced mixed results regarding HRT's efficacy.
- Conflicting data exists on whether HRT reduces cardiovascular events compared to placebo.
Conclusions:
- Specific conclusions can be drawn for particular HRT types and populations studied.
- Broader conclusions on HRT for cardiovascular disease prevention require additional research.
- Further trials are necessary to establish definitive recommendations for HRT use in postmenopausal women.
Abstract:
Cardiovascular disease remains the number one killer of women. Although important for the reduction of cardiovascular events, lipid alteration does not appear to be sufficient to obtain optimum reduction in cardiovascular risk. Women have a potential opportunity for further reduction in cardiovascular risk through postmenopausal hormone replacement therapy. More than 50 observational studies indicate that postmenopausal use of hormone replacement therapy reduces atherosclerosis and cardiovascular events. However, recently reported, randomized, controlled clinical trials have yielded mixed results as to whether hormone replacement therapy reduces cardiovascular events relative to placebo. These, as well as other randomized controlled trials of hormone replacement therapy and cardiovascular disease in postmenopausal women, are reviewed. Although conclusions concerning the specific hormones used in the specific populations studied can be offered from the completed trials, more broad conclusions concerning the use of hormone replacement therapy in the prevention of cardiovascular disease will have to await conduction and completion of other trials.
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