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Published on: August 13, 2019
Women, the menopause, hormone replacement therapy and coronary heart disease
Thomas F Whayne1, Debabrata Mukherjee
1aDivision of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky bDivision of Cardiovascular Medicine, Texas Tech University HSC, and Paul Foster School of Medicine, El Paso, Texas, USA.
Insights
Hormone replacement therapy (HRT) should not be used solely for cardiovascular disease prevention in women. However, HRT is safe and effective for managing menopause symptoms in the early years post-menopause when indicated.
Area of Science:
- Cardiology
- Endocrinology
- Women's Health
Background:
- Cardiovascular disease (CVD) is the leading cause of death in women, yet often underestimated.
- Menopause significantly impacts women's cardiovascular health, increasing risks.
- Hormone replacement therapy (HRT) is a key consideration in managing menopausal symptoms and cardiovascular risk.
Purpose of the Study:
- To review the relationship between hormone replacement therapy (HRT) and coronary heart disease (CHD) in women.
- To clarify the risks and benefits of HRT concerning cardiovascular health during menopause.
- To address misconceptions about women's risk of CHD.
Main Methods:
- Literature review focusing on HRT and cardiovascular outcomes in menopausal women.
- Analysis of mortality data comparing men and women post-myocardial infarction (MI).
- Examination of the impact of menopause timing and HRT use on cardiovascular risk.
Main Results:
- Women under 60 have a higher 2-year mortality rate post-MI compared to men.
- Cardiovascular disease and MI present subtly in women, with increased mortality post-menopause.
- Early or late menopause increases cardiovascular risk; HRT is not recommended for primary prevention but is low-risk within 10 years of normal menopause onset.
Conclusions:
- Hormone replacement therapy (HRT) should not be prescribed solely for cardiovascular risk reduction.
- HRT is appropriate and well-tolerated for symptom management in the early years after a normal-age menopause.
- Individualized assessment is crucial when considering HRT for menopausal women with cardiovascular concerns.
Purpose Of Review:
Cardiovascular disease considerations are associated with the menopause. Despite a misconception that women have a minimal risk for coronary heart disease (CHD), it is the major cause of female deaths. This review highlights issues of hormone replacement therapy (HRT) and CHD in women.
Recent Findings:
A woman under age 60, who suffers a myocardial infarction (MI), has a 2-year post-MI mortality of 28.9%; it is 19.6% in men. CHD and MI in women are subtle. In addition, female mortality from CHD increases after the menopause. The increased inflammatory risk factor status of women plays a role in development of atherosclerosis, before and after the menopause. Until after the menopause, women overall have a lower CHD mortality rate. Menopause is associated with unique symptoms, especially vasomotor ones; preexisting cardiovascular disease further exacerbates problems associated with the menopause. Use of HRT after the menopause is a major issue. Early menopause at age 39 years or younger and late menopause at age 56 years or older increase cardiovascular risk. HRT should not be prescribed for cardiovascular risk prevention, but when less than 10 years from menopause at a normal age, women can be reassured that cardiovascular risk from HRT is very low.
Summary:
Prescription of HRT should never be made only for cardiovascular risk reduction. However, when symptom-related and other indications are present, HRT is appropriate and well tolerated in the early years after menopause with onset at a normal age.
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