title: Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists.
abstract: Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.
authors.affiliation: NHLI, Imperial College London, Royal Brompton Hospital, Dovehouse Street, London SW3 6LY, UK. peter.collins@imperial.ac.uk
authors.forename: Peter
authors.initials: P
authors.lastname: Collins
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Rosano
authors.forename: Catherine
authors.initials: C
authors.lastname: Casey
authors.forename: Caroline
authors.initials: C
authors.lastname: Daly
authors.forename: Marco
authors.initials: M
authors.lastname: Gambacciani
authors.forename: Peyman
authors.initials: P
authors.lastname: Hadji
authors.forename: Risto
authors.initials: R
authors.lastname: Kaaja
authors.forename: Tomi
authors.initials: T
authors.lastname: Mikkola
authors.forename: Santiago
authors.initials: S
authors.lastname: Palacios
authors.forename: Richard
authors.initials: R
authors.lastname: Preston
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.forename: John
authors.initials: J
authors.lastname: Stevenson
authors.forename: Marco
authors.initials: M
authors.lastname: Stramba-Badiale
mesh_terms: D002318:Cardiovascular Diseases / Q000628:therapy*; D003276:Contraceptives, Oral / Q000009:adverse effects; D048909:Diabetes Complications; D050171:Dyslipidemias / Q000150:complications; D005060:Europe; D015444:Exercise; D005260:Female; D006176:Gynecology; D020249:Hormone Replacement Therapy; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008659:Metabolic Diseases / Q000150:complications; D047648:Perimenopause; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects
chemical_list: D003276:Contraceptives, Oral