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Coronary heart disease and hormone replacement therapy after the menopause

H N Hodis1, W J Mack

  • 1Atherosclerosis Research Unit, Keck School of Medicine, University of Southern California 90033, USA.

Climacteric : the Journal of the International Menopause Society
|October 9, 2009
PubMed

Insights

Hormone replacement therapy (HRT) initiation before age 60 and close to menopause reduces coronary heart disease (CHD) and mortality. Early HRT offers benefits comparable to other therapies with minimal risks.

Area of Science:

  • Cardiovascular Medicine
  • Endocrinology
  • Pharmacology

Background:

  • Observational studies and randomized controlled trials (RCTs) show conflicting outcomes regarding hormone replacement therapy (HRT) and coronary heart disease (CHD).
  • The "timing hypothesis" suggests HRT's risks and benefits depend on the age and timing of initiation relative to menopause.

Purpose of the Study:

  • To evaluate the impact of HRT and selective estrogen receptor modulators (SERMs) on CHD prevention based on the timing hypothesis.
  • To clarify the risks and benefits of HRT in women based on age at initiation and time since menopause.

Main Methods:

  • Analysis of data from large, randomized, controlled trials investigating HRT and SERMs for CHD prevention.
  • Review of cumulated literature on HRT use in relation to menopausal status and cardiovascular outcomes.

Main Results:

  • Initiating HRT in women under 60 years old and/or within 10 years of menopause reduces CHD and total mortality.
  • SERMs have demonstrated CHD reduction in women under 60.
  • Adverse effects of HRT in young postmenopausal women initiating therapy near menopause are rare and comparable to other common medications.
  • Primary prevention benefits for CHD with early HRT are equivalent to other standard therapies.
  • Longer duration of HRT use confers greater CHD benefits, particularly in women under 60 initiating therapy.

Conclusions:

  • The timing of HRT initiation is critical, with early initiation in younger postmenopausal women offering significant CHD and mortality benefits.
  • HRT, when initiated appropriately, presents a favorable risk-benefit profile for CHD prevention, comparable to other therapies.
  • Current literature dispels previous misconceptions regarding the risks of HRT for coronary heart disease.

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