Issues of hormone replacement therapy and cardiovascular disease for elderly women

Based on epidemiologic studies demonstrating mainly positive biologic effects of estrogen on cardiovascular risk factors and outcomes, earlier recommendations decreed that most, if not all women should be treated with long-term postmenopausal hormone replacement. A review of recent controlled clinical trials demonstrates that previously held dictums might not prove accurate. For elderly women, the decision to begin hormone replacement therapy should not be based on an assumption of protection from cardiovascular diseases. A careful assessment of the risks and benefits, as well as acknowledgement of the outcomes for which hormone replacement therapy has unknown impact, is needed for any decision to begin, continue, or stop hormone replacement therapy.