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An In Vivo Estrogen Deficiency Mouse Model for Screening Exogenous Estrogen Treatments of Cardiovascular Dysfunction After Menopause
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Published on: August 13, 2019

HRT as secondary prevention of cardiovascular disease

Olavi Ylikorkala1

  • 1Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland. olavi.ylikorkala@hus.fi

Maturitas
|April 6, 2004
PubMed

Insights

Postmenopausal hormone replacement therapy (HRT) is not effective for secondary prevention of heart disease or stroke. Evidence from randomized controlled trials indicates no benefit for preventing cardiac events or slowing atherosclerosis progression.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Public Health

Background:

  • Postmenopausal hormone replacement therapy (HRT) has been investigated for cardiovascular benefits.
  • Observational studies suggested HRT might reduce coronary artery disease (CAD) and stroke recurrence.
  • Conflicting evidence necessitates a review of HRT's efficacy in secondary prevention.

Purpose of the Study:

  • To evaluate the evidence for postmenopausal HRT's effectiveness in secondary prevention of coronary artery disease (CAD) and stroke.
  • To synthesize findings from randomized controlled trials (RCTs) and observational studies.

Main Methods:

  • Review of existing literature, including large-scale randomized, placebo-controlled trials (RCTs) like the Heart and Estrogen Replacement Study (HERS).
  • Analysis of non-randomized observational studies examining HRT use and cardiovascular event recurrence.
  • Assessment of studies investigating HRT's impact on coronary sclerosis and carotid atherosclerosis progression.

Main Results:

  • The HERS trial found no benefit of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) in secondary prevention of cardiac events.
  • RCTs showed no effect of CEE or CEE + MPA on coronary sclerosis progression.
  • Evidence regarding HRT and recurrent stroke risk is conflicting; one RCT showed slowed carotid arteriosclerosis progression with low-dose estrogen, while others found no benefit or risk.

Conclusions:

  • Current evidence indicates HRT has no role in the secondary prevention of coronary or carotid artery disease.
  • HRT use in patients with established cardiovascular disease should be based on nonvascular indications.
  • Potential benefits must outweigh risks, considering the lack of efficacy in cardiovascular secondary prevention.
Abstract

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