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Hormone replacement therapy in postmenopausal women with specific risk factors for coronary artery disease
M J van der Mooren1, V Mijatovic, W M van Baal
1Department of Obstetrics and Gynaecology, University Hospital-Vrije Universiteit, Amsterdam, The Netherlands. mj.vandermooren@azvu.nl
Insights
Hormone replacement therapy (HRT) significantly reduces coronary artery disease (CAD) risk in postmenopausal women. HRT favorably impacts cholesterol, lipoprotein(a) (Lp(a)), and homocysteine levels, especially in women with elevated concentrations.
Area of Science:
- Cardiovascular Health
- Endocrinology
- Women's Health
Background:
- Postmenopausal hormone replacement therapy (HRT) is linked to a 50% reduction in coronary artery disease (CAD) risk.
- Women with higher CAD risk appear to gain the most benefit from HRT.
Purpose of the Study:
- To review the existing literature on HRT's effects on cholesterol, lipoprotein(a) (Lp(a)), and homocysteine.
- To focus on HRT's impact on elevated levels of these cardiovascular risk factors.
Main Methods:
- Literature review of studies on HRT and cardiovascular risk factors.
- Analysis of HRT's effects on cholesterol, Lp(a), and homocysteine concentrations.
- Inclusion of HRT's impact on hypertension in women.
Main Results:
- HRT favorably modulates cholesterol, Lp(a), and homocysteine levels.
- The most significant reductions in these risk factors are observed in women with initially high concentrations.
- HRT may also benefit women with hypertension.
Conclusions:
- HRT is a promising strategy for cardiovascular risk reduction in postmenopausal women.
- Favorable modulation of cholesterol, Lp(a), and homocysteine by HRT is supported by current literature.
- Further clinical trials are needed to confirm the impact of reduced Lp(a) and homocysteine on clinical outcomes.
Abstract:
Hormone replacement therapy (HRT) in postmenopausal women is associated with a reduction in the risk of developing coronary artery disease (CAD) of about 50%. Women with an elevated risk for CAD appear to benefit most by HRT. The HRT-associated cardiovascular protection may be related to favourable changes in several important cardiovascular risk estimators, such as circulating blood concentrations of cholesterol, lipoprotein(a) (Lp(a)) and homocysteine. This paper reviews the literature presently available on the effects of HRT on cholesterol, Lp(a) and homocysteine concentrations, and special attention will be given to the effects on their elevated concentrations. The effect of HRT in women with hypertension is reviewed as well. From this overview it can be concluded that risk factors such as cholesterol, Lp(a), and homocysteine can be favourably modulated by HRT, and especially, that the strongest reductions can be achieved in those women with the highest concentrations. Although clinical trials still need to demonstrate the impact of lowering concentrations of Lp(a) and homocysteine, HRT appears to be a promising risk reduction strategy in this respect.