[Cardiovascular risks under hormone replacement therapy]

The discussion concerning the cardiovascular safety of hormone replacement therapy calls for a critical evaluation of the results of recent trials. In women arteriosclerotic cardiovascular disease has become the most frequent cause of death. Certainly not only the estrogen deficit can be hold responsible for the increasing cardiovascular risk with the menopause, since the prevalence of classical risk factors (i. e. overweight, metabolic syndrome) increases dramatically during the same period. The positive and negative effects of estrogens on the cardiovascular system are extraordinarily diverse, so that it is not reasonable to transfer isolated in-vitro-results to the situation in vivo. Likewise the results from observational studies or intervention trials in women of advanced age or with coronary heart disease cannot be applied to women in the perimenopause. Unfortunately intervention trials on the effect of hormone replacement therapy on coronary risk are lacking in this crucial period. The data of the Women's Health Initiative do not point to an increased risk at this stage. Therefore low dose estrogens can be reasonably applied for the relieve of menopausal symptoms after controlling the individual cardiovascular risk.