Hormone replacement therapy and cardiovascular disease.
Cardiovascular disease is the chief cause of death among women in industrialized countries. Even breast cancer deaths, at 100/100,000 annually, are only 20% those from cardiovascular disease. However, the research effort in the area of cardiovascular disease among postmenopausal women is far smaller than those for osteoporosis or cancer. In postmenopausal women, the risk of cardiovascular disease rises dramatically, and among the elderly exceeds that of males. Although there is overwhelming evidence that HRT reduces the incidence, many physicians assume that it may cause hypertension and thrombosis, perhaps under the mistaken impression that HRT has the same side effects as the first generation of steroid contraceptives. A number of studies have demonstrated that cardiovascular mortality of postmenopausal women on HRT decreases by approximately one-half. The main epidemiologic evidence for this is a series of case-control and prospective (cohort) studies. Some 20 studies over the last 15 years could be briefly summarized by saying that approximately one third found cardiovascular risk among HRT users to be reduced by > 50% compared with non-users; one third found risk reductions < 50%; and one third found increased risks. HRT appears to affect a large number of risk factors associated with cardiovascular disease; but many formerly thought to be of significance have little clinical relevance, whereas some factors, such as peripheral vascular resistance and certain prostanoids, are apparently much benefited. The benefits of HRT for lipid factors (HDL-cholesterol, LDL-cholesterol, etc.) are well known, but recent evidence indicates that changes in these lipids account for only 20-25% of the cardiovascular benefits of HRT.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Obstetrics & Gynecology, Lund University Hospital, Sweden.
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D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D008593:Menopause; D011372:Progestins / Q000494:pharmacology / Q000627:therapeutic use; D012307:Risk Factors
D008055:Lipids; D011372:Progestins