Primary prevention of coronary heart disease in women

Coronary heart disease (CHD) is a leading cause of death in women. Observational studies have consistently shown estrogen to help prevent CHD in postmenopausal women. The large randomised controlled Women's Health Initiative (WHI) trial initially did not confirm these observational findings. However, further analyses of the WHI study as well as meta-analyses of randomised clinical trials of hormone replacement therapy (HRT) and of the observational Nurses' Health Study have now found that the timing of onset of HRT use is important and that estrogen may have an important protective role in CHD, particularly in women initiating treatment below age 60 years. This BMS consensus statement will examine the evidence regarding HRT and non-estrogen therapies (lipid lowering agents, aspirin, antihypertensives, antidiabetic medications, SERMs) as well as diet, lifestyle and smoking cessation in the primary prevention of CHD in women.