[Menopausal hormone therapy and cardiovascular disease].
Despite biologically plausible mechanisms for cardiac protection and compelling evidence from observational studies suggesting that menopausal hormone therapy confers cardiovascular benefit, results of well-designed and conducted randomized clinical trials in healthy women and in women with established coronary heart disease displayed that menopausal hormone therapy failed to prevent clinical cardiovascular events and rather was associated with harms. Clinical trial of the SERM raloxifene also did not demonstrate a decrease in coronary events. It is unknown whether the earlier initiation of such therapies, i.e., at menopause, would result in favorable outcomes; or whether different hormonal preparations, lower doses, or alternate routes of administration would confer benefit. At present, proved coronary risk reduction strategies are requisite (albeit underutilized) for menopausal women; these include lifestyle and pharmacologic coronary preventive interventions. The baseline characteristics of menopausal women with coronary heart disease who were participants in cardiovascular outcome trials of menopausal hormone therapy or raloxifene were remarkably similar; globally, cardiovascular risk factors were not optimally controlled at entry into these trials, suggesting that more aggressive cardiovascular risk interventions are appropriate to achieve optimal target goals for menopausal women with documented coronary heart disease.
Wenger
Nanette K
NK
Emory University School of Medicine, Grady Memorial Hospital, Emory Heart and Vascular Center, Atlanta, Georgia, USA. nwenger@emory.edu
D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000139:chemically induced / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000517:prevention & control; D015331:Cohort Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000517:prevention & control; D004562:Electrocardiography; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008019:Life Style; D008327:Mammography; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use; D020521:Stroke / Q000139:chemically induced; D013997:Time Factors
D004967:Estrogens; D011372:Progestins; D020845:Selective Estrogen Receptor Modulators; D020849:Raloxifene Hydrochloride