Postmenopausal hormone therapy for cardiovascular health: the evolving data.

Area of Science:

• Endocrinology
• Cardiovascular Medicine
• Women's Health

Background:

• Postmenopausal hormone therapy (HT) was historically used for cardiovascular disease (CVD) prevention but declined after the Women's Health Initiative (WHI) study.
• WHI findings were broadly applied, impacting perceptions of all HT formulations, including modern human-identical hormones.
• Cardiovascular health is linked to estrogen status, yet HT is not currently recommended for primary or secondary CVD prevention.

Purpose of the Study:

• To review the history and evolving understanding of hormone therapy in cardiovascular health.
• To analyze the paradox of endogenous estrogen's cardioprotection versus apparent HT cardiotoxicity.
• To propose a specific HT regimen for potential cardiovascular benefits.

Main Methods:

• Review of key studies and scientific literature on hormone therapy and cardiovascular disease.
• Analysis of hormone terminology, function, and historical study outcomes.
• Synthesis of current evidence to inform therapeutic recommendations.

Main Results:

• Re-evaluation of WHI data and recent studies suggest a more nuanced view of HT's cardiovascular effects.
• Endogenous ovarian hormones appear cardioprotective, while HT's effects are debated.
• A specific HT approach is proposed based on evolving evidence.

Conclusions:

• HT is not recommended for primary or secondary CVD prevention currently.
• Further rigorous scientific analysis is needed to reconcile conflicting data on HT and cardiovascular health.
• If used, HT should be initiated immediately after menopause with transdermal estradiol and cyclic progesterone (P4).