[The effectiveness of estrogen replacement therapy to reduce ischemic heart disease--revaluation].
Cardiovascular disease is the leading cause of death of postmenopausal women in developed countries. One of the main reasons for providing hormone treatment for women was the possible prevention of ischemic heart disease (IHD). There are many cellular and molecular studies showing the effectiveness of estrogen in reducing risk factors of IHD, but none of these studies deal directly with the reduction of IHD. However, the studies that "prove" the direct effectiveness of estrogen in primary prevention of IHD are only observational studies. Doubts were raised, when two prospective, randomized, blinded studies (HERS and ERAT) were published, refuting the beneficial effect of estrogen in secondary prevention of IHD. Last July, part of the WHI study was published, showing increased risk for ischemic heart disease in patients treated with continuous combined HRT. In this era of Evidence Based Medicine, it is necessary to support decisions of treatment with prospective, randomized, blind trials. The publication of HERS I and II, ERAT and WHI, raised doubts concerning the ability of estrogen replacement treatment to be considered as primary or secondary prevention of IHD.
Ben-Chetrit
Avraham
A
Ramat Eshkol Womens Health Center, Jerusalem, Israel.
Zacut
David
D
Shimonovitz
Shlomo
S
D015914:Estrogen Replacement Therapy; D005260:Female; D006801:Humans; D017202:Myocardial Ischemia / Q000517:prevention & control*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results