[Cardiovascular Risks Under Hormone Replacement Therapy]

Overview

Journal Internist (Berl)

Specialty General Medicine

Date 2004 Jun 19

PMID 15205743

Authors

E Windler

Affiliations

Soon will be listed here.

Abstract

The discussion concerning the cardiovascular safety of hormone replacement therapy calls for a critical evaluation of the results of recent trials. In women arteriosclerotic cardiovascular disease has become the most frequent cause of death. Certainly not only the estrogen deficit can be hold responsible for the increasing cardiovascular risk with the menopause, since the prevalence of classical risk factors (i. e. overweight, metabolic syndrome) increases dramatically during the same period. The positive and negative effects of estrogens on the cardiovascular system are extraordinarily diverse, so that it is not reasonable to transfer isolated in-vitro-results to the situation in vivo. Likewise the results from observational studies or intervention trials in women of advanced age or with coronary heart disease cannot be applied to women in the perimenopause. Unfortunately intervention trials on the effect of hormone replacement therapy on coronary risk are lacking in this crucial period. The data of the Women's Health Initiative do not point to an increased risk at this stage. Therefore low dose estrogens can be reasonably applied for the relieve of menopausal symptoms after controlling the individual cardiovascular risk.

References

Butkevich A, Abraham C, Phillips R . Hormone replacement therapy and 24-hour blood pressure profile of postmenopausal women. Am J Hypertens. 2000; 13(9):1039-41. DOI: 10.1016/s0895-7061(00)00284-3. View

Hanggi W, Lippuner K, Riesen W, Jaeger P, Birkhauser M . Long-term influence of different postmenopausal hormone replacement regimens on serum lipids and lipoprotein(a): a randomised study. Br J Obstet Gynaecol. 1997; 104(6):708-17. DOI: 10.1111/j.1471-0528.1997.tb11982.x. View

Norman R, Flight I, Rees M . Oestrogen and progestogen hormone replacement therapy for peri-menopausal and post-menopausal women: weight and body fat distribution. Cochrane Database Syst Rev. 2000; (2):CD001018. DOI: 10.1002/14651858.CD001018. View

Stevenson J, Crook D, Godsland I . Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis. 1993; 98(1):83-90. DOI: 10.1016/0021-9150(93)90225-j. View

Ferrara A, Quesenberry C, Karter A, Njoroge C, Jacobson A, Selby J . Current use of unopposed estrogen and estrogen plus progestin and the risk of acute myocardial infarction among women with diabetes: the Northern California Kaiser Permanente Diabetes Registry, 1995-1998. Circulation. 2003; 107(1):43-8. DOI: 10.1161/01.cir.0000042701.17528.95. View

Newton K, LaCroix A, McKnight B, Knopp R, Siscovick D, Heckbert S . Estrogen replacement therapy and prognosis after first myocardial infarction. Am J Epidemiol. 1997; 145(3):269-77. DOI: 10.1093/oxfordjournals.aje.a009100. View

Mendelsohn M, Karas R . The protective effects of estrogen on the cardiovascular system. N Engl J Med. 1999; 340(23):1801-11. DOI: 10.1056/NEJM199906103402306. View

Kanaya A, Herrington D, Vittinghoff E, Lin F, Grady D, Bittner V . Glycemic effects of postmenopausal hormone therapy: the Heart and Estrogen/progestin Replacement Study. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2003; 138(1):1-9. DOI: 10.7326/0003-4819-138-1-200301070-00005. View

Herrington D, Vittinghoff E, Howard T, Major D, Owen J, Reboussin D . Factor V Leiden, hormone replacement therapy, and risk of venous thromboembolic events in women with coronary disease. Arterioscler Thromb Vasc Biol. 2002; 22(6):1012-7. DOI: 10.1161/01.atv.0000018301.91721.94. View

10.

Collins R, Peto R, Godwin J, Macmahon S . Blood pressure and coronary heart disease. Lancet. 1990; 336(8711):370-1. DOI: 10.1016/0140-6736(90)91908-s. View

11.

Wassertheil-Smoller S, Hendrix S, Limacher M, Heiss G, Kooperberg C, Baird A . Effect of estrogen plus progestin on stroke in postmenopausal women: the Women's Health Initiative: a randomized trial. JAMA. 2003; 289(20):2673-84. DOI: 10.1001/jama.289.20.2673. View

12.

Hulley S, Grady D, Bush T, Furberg C, Herrington D, Riggs B . Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998; 280(7):605-13. DOI: 10.1001/jama.280.7.605. View

13.

Miller J, Chan B, Nelson H . Postmenopausal estrogen replacement and risk for venous thromboembolism: a systematic review and meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2002; 136(9):680-90. DOI: 10.7326/0003-4819-136-9-200205070-00011. View

14.

. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131):837-53. View

15.

Manson J, Hsia J, Johnson K, Rossouw J, Assaf A, Lasser N . Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med. 2003; 349(6):523-34. DOI: 10.1056/NEJMoa030808. View

16.

Humphrey L, Chan B, Sox H . Postmenopausal hormone replacement therapy and the primary prevention of cardiovascular disease. Ann Intern Med. 2002; 137(4):273-84. DOI: 10.7326/0003-4819-137-4-200208200-00012. View

17.

Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M . Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. 2002; 288(1):49-57. DOI: 10.1001/jama.288.1.49. View

18.

Herrington D, Vittinghoff E, Lin F, Fong J, Harris F, Hunninghake D . Statin therapy, cardiovascular events, and total mortality in the Heart and Estrogen/Progestin Replacement Study (HERS). Circulation. 2002; 105(25):2962-7. DOI: 10.1161/01.cir.0000019406.74017.b2. View

19.

Finking G, Gohar M, Lenz C, Hanke H . [The effects of estrogen in the cardiovascular system]. Z Kardiol. 2000; 89(5):442-53. DOI: 10.1007/s003920050510. View

20.

Anderson G, Limacher M, Assaf A, Bassford T, Beresford S, Black H . Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA. 2004; 291(14):1701-12. DOI: 10.1001/jama.291.14.1701. View