Coronary Heart Disease in Women: Hormone Replacement Therapy

For both primary and secondary prevention of coronary heart disease (CHD), it is prudent to use strategies that are of proven benefit and that do not harm patients. In all women, these strategies include lifestyle approaches such as smoking avoidance, proper nutrition, and regular exercise. Lipid-lowering and blood pressure control with pharmacotherapy are indicated in women who do not meet target lipid or blood pressure levels with lifestyle interventions. For women with CHD, aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors should be considered. Widespread under-use of established preventive therapies has been documented in women. These interventions should be emphasized in clinical practice. For secondary prevention of CHD in women, the American Heart Association (AHA) recommends against initiating hormone replacement therapy (HRT) based on studies that have shown no benefit and early harm. For patients with CHD already on HRT, the decision to continue or stop HRT should be based on established noncoronary benefits and risks and patient preference. There are insufficient data to suggest that HRT should be initiated for the sole purpose of primary prevention of CHD. Because the new AHA guidelines recommend placing significant weight on the noncardiac benefits and risks of HRT, it is important to become familiar with these noncardiac effects. It is also important to understand the evidence supporting the AHA's decision to recommend placing relatively less weight on the cardiac effects of HRT.