[Biological and practical aspects of hormone replacement therapy: an approach to cardiovascular disease prevention in postmenopausal women].
Epidemiological and experimental clinical studies as well as basic laboratory research suggest that estrogen replacement therapy reduces the cardiovascular risk in postmenopausal women. Estrogens have different potential favourable effects (which remain to be fully proven in randomised clinical trials) on lipid metabolism, vascular endothelium and fibrinolysis. The molecular mechanisms adjacent to the vasodilator effects of estrogens have not yet been clearly defined, but many of the processes have already been characterised. Progestagens should be added to the estrogen therapy in women with an intact uterus in cyclic or continuous regimens, although the effects of progestagens on these processes (lipid metabolism and vascular function) are still being discussed. In an attempt to optimise and improve hormone replacement therapy compliance in postmenopausal women, we discuss the risks and benefits of this treatment according to the best available evidence. This evidence should help women decide which type of therapy is the most appropriate for them.
da Silva
P M
PM
Serviço de Medicina, Hospital de Santa Marta, Lisboa.
D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D010349:Patient Compliance; D017698:Postmenopause; D012307:Risk Factors; D014664:Vasodilation