Estrogens, lipids, and heart disease.
The routine prescription of hormone replacement therapy for elderly women to prevent heart disease is not indicated. Until better data are available, the use of estrogens primarily to prevent heart disease probably should be reserved for women at high risk by virtue of their LDL/HDL ratio or the presence of manifest coronary heart disease. There is no reason to give progestins to the woman without a uterus; unopposed oral estrogen should improve lipoproteins within a few weeks, and this change, if sustained, should reduce risk. The management of a woman with an intact uterus is more problematic given the unknowns about progestin's long-term effects on lipids or the heart and the unwillingness of many elderly women to resume regular (or irregular) bleeding. There are, however, many proven benefits of hormone replacement therapy, including the prevention of osteoporosis and urogenital atrophy. Decisions about when it is too late to start estrogen, or when it is time to stop it, will need to be made on a case-by-case basis.
Barrett-Connor
E
E
Department of Community and Family Medicine (0607), University of California, San Diego, La Jolla 92093.
Miller
V
V
D000367:Age Factors; D000368:Aged; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D004967:Estrogens / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D008593:Menopause; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D012737:Sex Factors; D016387:Women's Health
D004967:Estrogens