[Hormonal supplements for postmenopausal women: no evidence of protection against cardiovascular disease].
Atherothrombotic cardiovascular disease is a leading cause of death in women, especially in the postmenopause. It is controversial whether postmenopausal hormone replacement therapy is protective with regard to cardiovascular disease. On the one hand, observational studies consistently show that the risk of cardiovascular disease is 35 to 50% lower among users of hormonal replacement than among non-users. In addition, hormonal replacement is associated with an improvement of the lipid profile and several other potentially beneficial effects. On the other hand, two recent placebo-controlled randomised trials did not find evidence in favour of cardiovascular protection by hormonal replacement. This discrepancy may be explained by insufficient adjustment for lifestyle factors in observational studies and insufficient consideration of methodological flaws in experimental studies, both of which lead to an overestimation of the protective effect of hormonal replacement. Hormonal replacement may affect the pathophysiology of atherothrombosis in several ways, both positive and negative. Progress in this field requires the isolation of the positive effects.
Academisch Ziekenhuis Vrije Universiteit, afd. Algemene Inwendige Geneeskunde, De Boelelaan 1117, 1081 HV Amsterdam. cda.stehouwer@azvu.nl
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D000368:Aged; D001161:Arteriosclerosis / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control