Cardiovascular Disease: Reduced Mortality with Long-Term HRT Treatment
Several case-control as well as cohort studies indicate that estrogen replacement therapy reduces the risk of arterial disease, especially myocardial infarction. As with all observational studies there are limitations to each study. However, some of the cohort studies are large enough to control for a number of confounding factors. A meta-analysis on estrogen replacement therapy in cardiovascular disease would yield a relative risk of 0.5  in women using estrogen replacement therapy. Data on stroke are less clear. This is at least partly due to the fact that stroke occurs at a relatively more advanced age than myocardial infarction and few women use estrogens beyond 70 . There are also uncertainties about the venous side. Recent data imply that there is a 2–3 fold increase of venous thromboembolism at least during the first year of usage [3-5]. It is also established that estrogen confers protection against osteoporotic fractures and as hip fractures carry a mortality of about 20%, estrogen usage may impact on mortality. Furthermore, long-term use of hormone replacement therapy seems to increase the risk of the diagnosis of breast cancer; the relative risk being 1.3. Most data indicate that prognosis of breast cancers in women on HRT is better than in controls and that mortality in breast cancer may not be increased .
KeywordsBreast Cancer Hormone Replacement Therapy Venous Thromboembolism Estrogen Replacement Therapy Postmenopausal Estrogen
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