[Cardiovascular effects of replacement hormones]

The authors discuss the possibility of a consensus concerning hormone replacement therapy in relation with the risk of cardiovascular diseases in postmenopausal women anno 1995. Although there are not yet randomised clinical trials published concerning the effect of hormone replacement therapy, combined or not, on the incidence of coronary heart disease, the criteria for causal association seem to be indeed present. Relative risk of women on replacement therapy compared to those without such therapy is around 0.55; there is a gradient which expresses itself by an inverse correlation between the length of the hormonal replacement therapy and risk of coronary heart disease; this substitution therapy is most probably an independent protective factor; there are numerous possible pathogenetic mechanisms, the most important being likely a significant increase of HDL-cholesterol; animal experiments confirm the favourable effects of natural oestrogens on atherogenesis. Finally, a recent clinical trial seems to show that the favourable effects on the coronary risk profile are observed both with and without combined hormonal substitution therapy.