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[Hormone replacement therapy and the cardiovascular system: on the role of hemostasis]
1Zentrum für Frauenheilkunde, Universitätsklinikum Essen.
Postmenopausal women using hormone replacement therapy are likely to experience the first signs of cardiovascular disease at a higher age than women with a comparable risk-profile who choose not to use hormone replacement therapy. Epidemiologic as well as clinical evidence suggest that this benefit prevails even in risk groups such as hypercholsterinemic, hypertensive or diabetic women. Thus, hormone replacement therapy exerts its clinical benefit via steroidal effects on various metabolic pathways. We have reviewed these metabolic effects with particular reference to the differential impact of oral versus transdermal therapy. We have focused on the endothelial function as the common final pathway of all pathomechanisms associated with cardiovascular disease. Endothelial dysfunction may be assessed by analysis of the hemostatic system. Analysis of the available data on hemostatic effects reveals only minor differences between oral and transdermal therapy and gives no support to the notion that only oral hormone replacement therapy provides benefits with regard to cardiovascular disease.
Postmenopausal women using hormone replacement therapy are likely to experience the first signs of cardiovascular disease at a higher age than women with a comparable risk-profile who choose not to use hormone replacement therapy. Epidemiologic as well as clinical evidence suggest that this benefit prevails even in risk groups such as hypercholsterinemic, hypertensive or diabetic women. Thus, hormone replacement therapy exerts its clinical benefit via steroidal effects on various metabolic pathways. We have reviewed these metabolic effects with particular reference to the differential impact of oral versus transdermal therapy. We have focused on the endothelial function as the common final pathway of all pathomechanisms associated with cardiovascular disease. Endothelial dysfunction may be assessed by analysis of the hemostatic system. Analysis of the available data on hemostatic effects reveals only minor differences between oral and transdermal therapy and gives no support to the notion that only oral hormone replacement therapy provides benefits with regard to cardiovascular disease.