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Epidemiologic Studies on Ert and Cardioprotection: State of the Art on HRT and Cardiovascular Disease

  • Chapter
Women’s Health in Menopause

Part of the book series: Medical Science Symposia Series ((MSSS,volume 7))

Abstract

Cardiovascular diseases remain the leading cause of death in American women. Evidence from epidemiologic studies indicates that estrogen replacement therapy in postmenopausal women can reduce their risk of coronary heart disease. Current users, in particular, appear to enjoy the most substantial cardiac benefits. A meta-analysis of population-based case-control studies, cross-sectional studies, and prospective studies of current estrogen use yielded a summary relative risk of 0.49 (95% confidence interval 0.43–0.56). It remains possible that the protective effect of estrogen observed in these studies may be due, in part, to bias. Women who use estrogen see a physician regularly, and compliance to estrogen therapy may identify a low-risk group of women. Furthermore, women who choose to use estrogen may lead generally healthier lifestyles than those who do not take such medication. However, adjustment for known cardiac risk factors in many of the large studies had little impact on the results, implying an equivalent risk status for users and nonusers. In addition, both animal and human studies demonstrate that estrogen use lowers LDL and increases HDL cholesterol levels, improves blood flow, and reduces atherosclerosis. The effect of progestin added to estrogen therapy has not been adequately assessed, but initial evidence suggests that it may somewhat attenuate, although not completely eliminate the benefits of estrogen on cardiovascular disease.

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Authors and Affiliations

  1. Department of Epidemiology, Harvard School of Public Health and Channing Laboratory, Boston, MA, 02115, USA

    Francine Grodstein & Meir J. Stampfer

  2. Department of Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA, 02115, USA

    Francine Grodstein & Meir J. Stampfer

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  1. Francine Grodstein
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Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Milan, Milan, Italy

    P. G. Crosignani

  2. Institute of Pharmacological Sciences, University of Milan, Milan, Italy

    R. Paoletti

  3. Department of Obstetrics and Gynecology, Yale University, School of Medicine, New Haven, Connecticut, USA

    P. M. Sarrel

  4. Department of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA

    N. K. Wenger

  5. Clinica Menopausa, Milan, Italy

    M. Meschia (Assistant Editor) (Assistant Editor)

  6. Institute of Pharmacological Sciences, University of Milan, Milan, Italy

    M. Soma (Assistant Editor) (Assistant Editor)

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© 1994 Springer Science+Business Media Dordrecht

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Grodstein, F., Stampfer, M.J. (1994). Epidemiologic Studies on Ert and Cardioprotection: State of the Art on HRT and Cardiovascular Disease. In: Crosignani, P.G., Paoletti, R., Sarrel, P.M., Wenger, N.K., Meschia, M., Soma, M. (eds) Women’s Health in Menopause. Medical Science Symposia Series, vol 7. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-1024-2_16

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  • DOI: https://doi.org/10.1007/978-94-011-1024-2_16

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-4446-2

  • Online ISBN: 978-94-011-1024-2

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