Hormonal therapy: does it increase or decrease cardiovascular risk?

The use of hormonal therapy (HT) has become one of the most controversial topics in the area of women's health. A particular area of confusion has been the issue of cardiovascular benefit versus cardiovascular risk for women using HT. Although years of observational data have suggested that women receiving HT have a lower incidence of coronary artery disease (CAD) and longer survival, several prospective, randomized controlled trials have brought this tenet into debate. This article provides a historical perspective on the role of HT and CAD. The Heart and Estrogen/Progestin Replacement Study (HERS) and the Women's Health Initiative (WHI) data are analyzed in conjunction with newer data. Finally, an explanation will be provided as to how early initiation of HT could afford cardiovascular protection and not contradict the HERS and WHI.

Obstetricians & Gynecologists, Family Physicians.

After completion of this article, the reader should be able to state that controversy still remains in the use of hormonal therapy (HT) for menopause, explain that there are conflicting data from both prospective and observational studies, and recall that a new look at prospective data may indicate that HT has beneficial cardiovascular effects.