Postmenopausal hormone therapy and cardiovascular disease in women.
OBJECTIVE
The belief in the hypothesis of cardiovascular benefit of hormone therapy (HT) in postmenopausal women was widespread; however, the Women's Health Initiative (WHI) hormone trials found no evidence of coronary heart disease (CHD) benefit among women aged 50-79 with no prior CHD diagnosis and HT increased risk of stroke. This article reviews the literature regarding HT and CHD, with emphasis on the findings from the WHI trials.


RESULTS
Findings from observational studies and animal studies addressing biological plausibility that had been interpreted as evidence to support the use of HT were reviewed and findings from the trials of women with cardiovascular disease and the WHI hormone trials are summarized, with specific commentary on the issue of differential effects of HT in younger versus older women.


CONCLUSIONS
HT should not be prescribed for the purpose of preventing cardiovascular disease. The WHI offered support for the current U.S. Food and Drug Administration recommendation to limit HT to short-term use. There is a clear need for a greater understanding of the effects of both endogenous and exogenous estrogens in relationship to the aging cardiovascular system.
Stefanick
M L
ML
Stanford Prevention Research Center, Stanford University School of Medicine, Medical School Office Building, 251 Campus Drive, Room X308, Stanford, CA 94305-5411, United States. stefanick@stanford.edu
D000368:Aged; D000375:Aging; D000818:Animals; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology / Q000517:prevention & control; D015914:Estrogen Replacement Therapy / Q000009:adverse effects* / Q000639:trends; D004967:Estrogens / Q000009:adverse effects / Q000494:pharmacology; D005260:Female; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011372:Progestins / Q000009:adverse effects / Q000494:pharmacology; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States; D014486:United States Food and Drug Administration; D016387:Women's Health
D004967:Estrogens; D011372:Progestins