[Vascular risk and menopause: role of hormone replacement therapy].
BACKGROUND
Menopause dramatically increases cardiovascular risk in women who lack the protecting effects of estrogens. This emphasizes the importance of hormone replacement therapy (HRT) which, until recently, was considered beneficial in spite of the heterogeneous nature of clinical studies. Such a benefit was supposed to result from the favorable effects of estrogens, including lipid lowering and a complex vasodilating action including the improvement of vascular endothelial function.
The results of the HERS study have however questioned these affirmations because of the lack of clinical benefit due to HRT in secondary prevention of coronary artery disease in postmenopausal women, with an increased vascular risk during the first year of treatment. In clinical practice, it is not recommended to start HRT after a cardiac attack.


CONCLUSIONS
In fact, the HERS study used a conjugated equine estrogen and progestin (with possible deleterious effects) and cannot be compared to French prescription habits which are based on the use of natural hormones. However, it remains to be demonstrated that some HRT regimens, in particular those using progesterone, may provide a real benefit in terms of lower cardiovascular morbidity-mortality.
Garnier
L F
LF
Service de Cardiologie, Centre Hospitalier, Vendôme.
Bourges
O
O
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D002986:Clinical Trials as Topic; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D018570:Risk Assessment
Risque vasculaire de la ménopause: intérêt du traitement hormonal substitutif.