Menopausal Hormonal Therapy and Cardiovascular Disease
- 154 Downloads
Cardiovascular disease is the leading cause of death in women. Older observational studies suggested a significant protective effect of menopausal hormone therapy (MHT) for coronary heart disease (CHD) when prescribed for women at the onset of menopause; and this also translated into a significant reduction in mortality as well. Multiple mechanisms have been found to support these findings. Various secondary prevention trials and the use of hormones in older women have shown negative findings and a trend for more coronary events in these women with atherosclerotic plaque. Data from the Women’s Health Initiative in younger women confirm the data in the observational studies showing a protective effect on CHD and mortality for conjugated equine estrogens (CEE) alone, whereas the data with CEE and medroxyprogesterone acetate do not show as positive an effect. Recent trials testing the “timing” hypothesis also have confirmed these data for benefit in younger women, but not in older women. Because prevention of diseases after menopause should be a major goal of providers of health care for women, the consideration of using MHT, particularly the use of estrogen, may once again be considered as part of this prevention strategy.
KeywordsCoronary heart disease Mortality Menopause Estrogen Progestogen Prevention
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Statistical Fact Sheet 2014 Update.www.heart.org.
- 2.Weiss NS. Relationship of menopause to serum cholesterol and arterial blood pressure: the United States health examination survey of adults. Am J Epidemiol. 1972;96:237–41.Google Scholar
- 9.Grady D, Rubin SM, Petitti DB, et al. Hormone therapy to prevent disease and prolong life in postmenopausal women. Altern Med. 1991;117:1016–37.Google Scholar
- 16.Hu P, Greendale GA, Palla SL, et al. The effects of hormone therapy on the markers of inflammation and endothelial function and plasma matrix metalloproteinase-9 level in postmenopausal women: the Postmenopausal Estrogen Progestin Intervention (PEPI) trial. Atherosclerosis. 2006;185:347–52.PubMedCrossRefGoogle Scholar
- 20.•Manson JE, Chlebowski RT, Stefanick ML, et al. Menopausal hormone therapy and health outcomes during the intervention and extended post stopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013;310:1353–68. This is the most recent follow-up of the hormone trials from the WHI. The data in the 50–59-year-old group with CEE alone show significant benefit. The conclusion of the authors that there is no role in prevention should be challenged.PubMedCrossRefGoogle Scholar
- 26.Harmon SM, Black DM, Naftolin F, et al. Arterial imaging outcomes and cardiovascular risk factors in recently menopausal women in the Kronos Early Estrogen Prevention study (KEEPS): A randomized controlled trial. Annals of Int Med. 2014Google Scholar
- 27.Hodis HN. ELITE – Does the trial outcome confirm or refute the timing hypothesis of hormone therapy? Cancun: Presented at the 14th World Congress on Menopause of the International Menopause Society; 2014.Google Scholar
- 28.•Schierbeck IL, Renmark L, Tofteng CL, et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomized trial. BMJ. 2012;345:e6409. Prospective trial in 1,006 women at the onset of menopause treated with MHT for 10 years, followed for up to 16 years, and showing a significant reduction in CHD.PubMedCrossRefGoogle Scholar
- 43.•Lobo RA, Davis SR, De Villiers TJ, et al. Prevention of diseases after menopause. Climacteric. 2014;17:1–17. This is a “white” paper written on behalf of the International Menopause Society for the 2014 theme of World Menopause Day. It stresses the role of prevention for women after menopause and explores in detail the potential beneficial role of estrogen as part of this strategy.Google Scholar