Cardiovascular risk and hormonal replacement therapy at menopause

Based on observational studies in the 1990s, hormonal replacement therapy (HRT) was considered clearly beneficial in terms of prevention

of cardiovascular disease in postmenopausal women. A major surprise have been the results of well-conducted intervention studies (e.g.,

HERS and WHI) that failed to demonstrate beneficial effects of HRT in both secondary and primary prevention of atherosclerosis and its

complications. However, recent research, development of novel types of HRT, and new practical approaches to its use may change the

attitude of internists and cardiologists toward indicating HRT.

Obviously, individually selected and, in particular, early indicated HRT favourably affects the presence of the metabolic syndrome components

(dyslipidaemia, blood pressure level) in perimenopausal women, and reduces the risk of developing diabetes. Subanalyses of

the studies (including the WHI study cited here) have revealed that HRT may be associated with a cardiovascular benefit provided that

the essential conditions are met: individual risk assessment, appropriate timing, dose, and type of the preparation selected. Early indication

for HRT as well as HRT preparations with low hormone doses and with new gestagens administered for no longer than necessary

are the options of alleviating menopausal complaints without negatively affecting cardiovascular risk.

Keywords: cardiovascular disease, atherosclerosis, menopause, hormonal replacement therapy.