Hormone replacement therapy and cardiovascular disease: an evidence based approach

The recently reported results of one of the arms of the Women's Health Initiative (WHI) (the Estrogen + Progestin arm) have sparked a substantial amount of debate and controversy over the interpretation of the study findings and their implications for the practice of medicine, in particular in reference to the role that hormone therapy (HT) has in the prevention of coronary heart disease (CHD). The WHI study is the only large randomized clinical trial that, to date, has addressed the issue of HT in the primary prevention of CHD and has provided evidence that the formulation used in the study does not provide CHD benefits and increases the overall risk for cardiovascular disease. The WHI findings, together with the findings from other clinical trials that have been published since the initiation of WHI, provide no support for HT in cardiovascular disease prevention. Questions regarding different formulations and administration routes still remain, however, the prudent and sensible approach, while we collect the evidence on these important issues, is to refrain from considering HT a viable solution to the prevention of CHD in post-menopausal women.