The cardiovascular effect of hormone replacement therapy in women
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
14
Journal Issue
4
Pages
149-156
Date Issued
2003
Author(s)
Abstract
It is well documented that coronary heart disease (CHD) is the leading cause of death in women - especially in postmenopausal women. Women with CHD are always underdiagnosed and they have higher read-mission rate and mortality rate after myocardial infarction (MI). Premenopausal women with intact ovaries are in far lower risk of CHD compared to men in the same age group. However, the risk of CHD in women increases substantially after menopause. Early epidemiological and biological studies all inferred the cardioprotective role of endogenous estrogen might be resulted from the beneficial effects on lipid profile and on atherosclerosis retardation. Later observational studies showed that hormone replacement therapy (HRT) decreased CHD risk in postmenopausal women. Since 1970s, more than 30 large observational studies and several meta-analysis all supported this finding. Thus, HRT on primary and secondary prevention of CHD was suggested by major medical organizations such as the American College of Physicians and American College of Obsterians and Gynecologists. Furthermore, HRT has other potential benefits, such as osteoporosis retardation. Surprisingly, recent randomized clinical trials investigating the relationship between HRT and CHD have widely divergent results from earlier observational studies. The Heart and Estrogen/Progestin in Replacement Study (HERS) and The Estrogen Replacement in Atherosclerosis (ERA) trial concluded that HRT did not reduce overall risk for CHD events in postmenopausal women with CHD. In addition, Women's Health Initiative (WHI) also provided data to support that combined HRT with estrogen-progestin has no role on primary prevention of CHD in postmenopausal women and the overall health risks exceed benefits after an average 5.2-year follow-up. Nevertheless, long term effect of estrogen alone remains unclear and the results would be forthcoming from ongoing part of the WHI study. It seems that there is a long way to clarify the confounding effect of route of administration, the types and dosages of estrogens and progestins, the age and the time after menopause for the initiation of therapy, and other factors. A therapeutic advance, the Selective Estrogen-Receptor Modulators (SERMs), exerts selective agonist or antagonist effects on various estrogen targets and is proposed to have all beneficial effects of estrogen, but none of its adverse effect, and offers protection against breast cancer. The cardioprotective effect of these new agents in women with or without CHD needs to be clarified by further large, randomized clinical trials.
SDGs
Other Subjects
estrogen; gestagen; lipid; selective estrogen receptor modulator; article; atherosclerosis; breast cancer; cardiovascular effect; cause of death; coronary risk; estrogen therapy; female; follow up; health care organization; health hazard; heart protection; hormone substitution; hospital admission; human; ischemic heart disease; medical documentation; menopause; mortality; osteoporosis; postmenopause; premenopause; primary prevention; risk assessment; secondary prevention
Type
journal article