Postmenopausal Hormone Therapy: Does It Have a Role in Cardiovascular Prevention Today?
Cardiovascular disease is the leading cause of mortality in women. Results from observational studies consistently demonstrated lower heart disease rates among women who used hormone replacement therapy (HRT) compared to non-users. Data from two large randomized controlled trials showed mixed results. Subsequent post-hoc analysis found cardiovascular disease among HRT users to be lower than non-users in women 50 to 59 years of age or less than 10 years post-menopause. This has sparked much debate on the role of postmenopausal hormone therapy, especially in peri-menopausal women. Two hypotheses have been suggested to explain this divergent data: 1) HRT may be cardioprotective when introduced prior to atherosclerosis development but may be harmful in women with established CVD; or 2) HRT may be useful when started closer to menopause initiation and harmful when started later in life.