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[The effectiveness of estrogen replacement therapy to reduce ischemic heart disease--revaluation]
Avraham Ben-Chetrit1, David Zacut, Shlomo Shimonovitz
1Ramat Eshkol Womens Health Center, Jerusalem, Israel.
Insights
Estrogen replacement therapy may not prevent ischemic heart disease (IHD) in postmenopausal women. Recent trials question its effectiveness for both primary and secondary IHD prevention.
Area of Science:
- Cardiovascular Health
- Endocrinology
- Clinical Trials
Context:
- Cardiovascular disease is the primary cause of mortality in postmenopausal women.
- Hormone replacement therapy (HRT) was historically considered for ischemic heart disease (IHD) prevention.
- Observational studies suggested estrogen's benefits, but lacked direct IHD reduction data.
Purpose:
- To evaluate the effectiveness of estrogen replacement treatment in the primary and secondary prevention of ischemic heart disease (IHD).
- To critically assess HRT's role in cardiovascular health for postmenopausal women based on robust clinical evidence.
Summary:
- While cellular studies indicate estrogen reduces IHD risk factors, direct evidence for IHD reduction is limited.
- Randomized trials like HERS, ERAT, and WHI have challenged the protective effects of estrogen in IHD.
- These studies indicate potential increased risk for IHD with continuous combined HRT, questioning its preventative role.
Impact:
- Evidence-based medicine necessitates randomized trials to confirm therapeutic benefits.
- Findings from HERS, ERAT, and WHI raise significant doubts about estrogen replacement therapy for IHD prevention.
- Clinical decisions regarding HRT for postmenopausal women's cardiovascular health require re-evaluation.
Abstract:
Cardiovascular disease is the leading cause of death of postmenopausal women in developed countries. One of the main reasons for providing hormone treatment for women was the possible prevention of ischemic heart disease (IHD). There are many cellular and molecular studies showing the effectiveness of estrogen in reducing risk factors of IHD, but none of these studies deal directly with the reduction of IHD. However, the studies that "prove" the direct effectiveness of estrogen in primary prevention of IHD are only observational studies. Doubts were raised, when two prospective, randomized, blinded studies (HERS and ERAT) were published, refuting the beneficial effect of estrogen in secondary prevention of IHD. Last July, part of the WHI study was published, showing increased risk for ischemic heart disease in patients treated with continuous combined HRT. In this era of Evidence Based Medicine, it is necessary to support decisions of treatment with prospective, randomized, blind trials. The publication of HERS I and II, ERAT and WHI, raised doubts concerning the ability of estrogen replacement treatment to be considered as primary or secondary prevention of IHD.