title: Is postmenopausal hormone replacement therapy suitable after a cardio- or cerebrovascular event?
abstract: OBJECTIVE
  Vascular disease is the leading cause of death in women. One-third of acute events affect women below age 60, when the prevalence of menopausal symptoms is high. This raises the question if hormone replacement therapy (HRT) may be an appropriate treatment for individual women although vascular disease is generally considered a contraindication.
  
  
  METHODS
  Selective literature search was used for this study.
  
  
  RESULTS
  In healthy women, HRT increases risks for venous thromboembolism and ischemic stroke, but for cardiovascular disease apparently only beyond 10 years after menopause or 60 years of age. Limited data in women with cardio or cerebrovascular disease have not demonstrated an increased risk for a vascular recurrent event, but for the first year after initiation. In HRT users affected by a cardiovascular event continuation of HRT has not been found to be associated with adverse outcome. Low dose estradiol--preferentially as transdermal patches, if necessary combined with metabolically neutral progestins--appears to convey lower risk.
  
  
  CONCLUSIONS
  Safety data on HRT in survivors of cardiovascular events or ischemic stroke are limited, but exceptionally increased risk appears to be excluded. If off-label use of HRT is considered to be initiated or continued in women with cardio- or cerebrovascular disease, extensive counseling on the pros and cons of HRT is mandatory.
authors.affiliation: Preventive Medicine, University Heart Center, University Hospital Hamburg-Eppendorf, Martinistr. 52, Bldg. N36, 20246, Hamburg, Germany, Windler@uke.uni-hamburg.de.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Windler
authors.forename: Petra
authors.initials: P
authors.lastname: Stute
authors.forename: Olaf
authors.initials: O
authors.lastname: Ortmann
authors.forename: Alfred O
authors.initials: AO
authors.lastname: Mueck
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology*; D004958:Estradiol / Q000008:administration & dosage; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D011372:Progestins / Q000008:administration & dosage; D012306:Risk; D020521:Stroke / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology*
chemical_list: D011372:Progestins; D004958:Estradiol