[Hormone replacement in postmenopausal women with coronary heart disease. Results and clinical consequences from...

Despite the comparable risk profile, women in reproductive age have less frequently cardiovascular disease than men. Hormone replacement therapy in postmenopausal women is associated with further reduction of coronary artery disease and myocardial infarction. There is good evidence, that estrogens cause these differences. Several well observed biological effects of estrogens seem to be responsible for this benefit. Estrogen replacement therapy reduces cholesterol and LDL-cholesterol levels and has also some antioxidant potential. Furthermore estrogens have effects on vasodilation of the coronary arteries. A benefit on haemostasis through fibrinogen attenuation and platelet inhibition is also described. A main problem of patients compliance during estrogen replacement therapy are postmenopausal bleeding and being afraid of breast cancer. Hormone replacement therapy is indeed not without any risk. The incidence of breast cancer is controversially discussed. Thrombosis and pulmonary infarction are described as further risks. Comparing the risks and benefits of estrogen replacement therapy concerning the reduction of cardiovascular disease, actually the objections are to be dissipated from an epidemiological point of view. Thus if the results of the ongoing large randomized studies prove, that estrogen replacement therapy reduces the risk of coronary artery disease, a challenge in primary- and secondary prevention of cardiovascular disease in women will have to occur.