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Hormone replacement therapy and cardiovascular disease revisited

John C Stevenson1

  • 1National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. j.stevenson@imperial.ac.uk

Menopause International
|May 26, 2009
PubMed

Insights

Hormone replacement therapy (HRT) may offer cardiovascular benefits for postmenopausal women, particularly when initiated before age 60. Re-evaluation of trial data suggests HRT is a potential preventive treatment for coronary heart disease (CHD).

Area of Science:

  • Cardiovascular Health
  • Endocrinology
  • Women's Health

Background:

  • Controversy exists regarding the cardiovascular benefits and risks of hormone replacement therapy (HRT).
  • Estrogen demonstrates biological benefits for cardiovascular health, supported by epidemiological data.
  • Previous findings from the Women's Health Initiative (WHI) trial suggested HRT increased coronary events.

Purpose of the Study:

  • To re-evaluate the cardiovascular benefits and risks of hormone replacement therapy (HRT) in postmenopausal women.
  • To clarify the impact of HRT on coronary heart disease (CHD) prevention.
  • To assess the safety and efficacy of HRT in light of updated Women's Health Initiative (WHI) data.

Main Methods:

  • Analysis of comprehensive data from the Women's Health Initiative (WHI) randomized, placebo-controlled clinical trial.
  • Examination of cardiovascular events, stroke, venous thromboembolism, and breast cancer incidence in HRT users versus placebo.
  • Subgroup analysis based on age at initiation of HRT.

Main Results:

  • Updated WHI data show no significant increase in coronary heart disease (CHD) with HRT.
  • A trend towards reduced CHD was observed in women initiating HRT before age 60.
  • Subsequent findings did not confirm a clear increase in breast cancer risk associated with HRT.

Conclusions:

  • Preliminary WHI findings did not accurately represent the true benefits and risks of HRT.
  • HRT should be considered a potential preventive treatment for coronary heart disease (CHD) in postmenopausal women.
  • HRT may be particularly beneficial for primary prevention of CHD when initiated at a younger age.

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