Effect of postmenopausal hormone therapy on cardiovascular risk

The role of postmenopausal hormone therapy for the prevention and treatment of coronary heart disease remains an important unanswered question. Clinical trials have not yet produced evidence of benefit, and at least one trial has suggested initial harm after initiation of therapy. The data from observational epidemiology remain supportive of benefit, however these data are subject to various biases and interpretations. Mechanistic studies support either potential benefit or potential harm. Postmenopausal hormone therapy should not be recommended for the prevention of coronary heart disease until the potential early harm has been explained, methods of screening out women at high risk have been devised, and long-term benefit has been demonstrated in randomized controlled clinical trials.