Cardiovascular disease after menopause: a growing epidemic

Coronary heart disease (CHD) remains the major cause of mortality in women after menopause. At the time of menopause risk factors change to increase the risk of CHD. Although hormone replacement therapy improves some of these risk factors, no overall cardiovascular benefit has been noted with this therapy. There are parallel twin epidemics occurring in postmenopausal women, one being cardiovascular disease and the other metabolic syndrome, in which there appears to be a connection. Metabolic risk factors such as elevated triglyceride levels, decreased HDL-cholesterol levels and glucose abnormalities have been suggested to portend a greater CHD risk in women than men. Also the inflammatory marker, C reactive protein, appears to modify risk at all levels of the metabolic syndrome. Further studies are needed to determine the best strategy to confront the epidemic of cardiovascular morbidity and mortality in the postmenopausal population.