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Hormone replacement therapy and heart disease: the remains of the oestrogen hypothesis

A H E M Maas, Y T van der Schouw, D E Grobbee

    Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
    |February 20, 2015
    PubMed

    Insights

    Hormone replacement therapy (HRT) effects on cardiovascular health differ based on timing. Starting HRT long after menopause, especially after a cardiovascular event, increases risks, while chronic use may not be harmful.

    Area of Science:

    • Cardiovascular Science
    • Endocrinology
    • Pharmacology

    Background:

    • Observational studies suggest hormone replacement therapy (HRT) protects postmenopausal women from cardiovascular disease.
    • However, randomized trials indicate HRT may harm the vascular system.

    Approach:

    • This review examines HRT's impact on lipids, hemostasis, inflammation, and the vascular wall.
    • It postulates reasons for discrepancies between observational and experimental findings.
    • The crucial role of timing in HRT's vascular effects is highlighted.

    Key Points:

    • Chronic HRT use may not pose risks.
    • Initiating HRT after a cardiovascular event increases adverse events.
    • The menopausal interval before HRT initiation is critical.

    Conclusions:

    • HRT is more effective in maintaining vascular health than reversing endothelial dysfunction.
    • HRT is detrimental for women at cardiovascular risk.
    • The timing of HRT initiation significantly influences its vascular outcomes.
    Abstract

    Keywords:
    cardiovascular diseasehormone replacement therapyprevention

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