[Prevention of atherosclerosis by estrogen substitution?]

Epidemiological, experimental and clinical data verify that the risk of cardiovascular diseases is increased by a long-term estrogen deficiency. This is, among other things, caused by alterations of lipid metabolism (e.g., rise in total cholesterol and LDL-cholesterol, decrease in HDL-cholesterol) due to the estrogen dificit which are involved in an accelerated development of atherosclerosis. If there is an estrogen deficiency, an elevated serum level of cholesterol or LDL-cholesterol can be reduced and the HDL-cholesterol level can be increased by an adequate estrogen replacement therapy, i.e., treatment with an estrogen and progestogen the type and dose of which are adjusted to the clinical picture. When the present knowledge about the physiological and pathological pathways is weighed and the epidemiological data are critically valued - whereby the extent and duration of the stage of estrogen deficit has to be regarded as an important criterion -, it can be assumed that an estrogen therapy prevents a premature atherosclerosis and coronary heart disease provided that they are related to an estrogen deficiency. The differences in the degree of estrogen deficit and the symptoms as well as in the pharmacological and pharmacodynamic peculiarities if the individual women render it necessary to adjust individually the estrogen therapy, to avoid overdosing and to pay attention to risk factors. Therefore, an undifferentiated treatment with estrogens (e.g. estrogen for every woman) does not appear to be appropriate.