Lessons from hormone replacement therapy trials for primary prevention of cardiovascular disease.
OBJECTIVE
Coronary heart disease in women is a common cause of morbidity and mortality, particularly after menopause. It was thought that estrogen and progesterone protected women from coronary heart disease. The recommendations of the recent Women's Health Initiative, however, are that hormone replacement therapy should not be used for primary prevention of coronary heart disease in women. Here, we have made a comprehensive review of major studies and comment on the validity of this recommendation. We have also analyzed the importance of dietary modification in primary prevention. In addition, we have delineated the important predictors of cardiovascular disease in women from prior observational and clinical studies.


RESULTS
Recent major studies, including the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS), studied the role of hormone replacement therapy in protecting women from coronary heart disease. These studies showed no significant reduction in coronary heart disease events. In addition, the dietary modification component of the Women's Health Initiative did not show any significant reduction in the incidence of coronary heart disease.


CONCLUSIONS
It can be summarized that hormone replacement is not generally recommended in postmenopausal women for primary prevention of coronary heart disease. Although the dietary modification trials did not show any significant reduction in the incidence of coronary heart disease, it is currently recommended to continue using a heart-healthy diet.
Mohandas
Bhavna
B
Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Mehta
Jawahar L
JL
D000368:Aged; D015415:Biomarkers / Q000097:blood; D003327:Coronary Disease / Q000178:diet therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004562:Electrocardiography; D004967:Estrogens / Q000627:therapeutic use*; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000150:complications; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D017698:Postmenopause; D011372:Progestins / Q000627:therapeutic use*; D012307:Risk Factors; D016387:Women's Health
D015415:Biomarkers; D004967:Estrogens; D011372:Progestins