[Hormone replacement therapy and cardiovascular prevention: many statements, some doubts]

Results of randomized, placebo-controlled clinical trials with major clinical endpoints as well as with angiographic or echographic endpoints recently completed with hormone replacement therapy in postmenopausal women, are critically discussed. These results, far from confirming the protective cardiovascular effect previously found in observational studies, showed that hormone replacement therapy is associated with an increase of coronary risk, mainly in the first year of treatment, of stroke, as well as of venous thromboembolism and invasive breast cancer. Various plausible explanations, both from the methodological and the biological point of view, for the divergent findings between the randomized clinical trials and the observational studies are critically examined. On the basis of the available data, no cardiovascular preventive role must be assigned to the hormone replacement therapy; the only today accepted indication remains the short-term treatment of postmenopausal vasomotor disturbances.