HRT and cardi ovascular risk

Česká verzia

Authors: H. Rosolová
Authors place of work: Lékařská fakulta v Plzni, Český institut metabolického syndromu, o. p. s. ; Centrum preventivní kardiologie, II. interní klinika UK Praha
Published in the journal: Kardiol Rev Int Med 2009, 11(3): 134-137
Category: Nontraditional risk factors cardiovascular disease

Summary

The age of the onset of natural menopause has not changed significantly over the past 150 years, while the median life expectancy continues to increase. Therefore, a woman‘s life in menopause lengthens. Symptoms as well as disorders associated with menopause have become an important health problem. Among other issues, menopause is linked to a significant deterioration of the risk profile for atherosclerosis and to increased incidence of cardiovascular diseases (CVD). Estrogens have a range of protective properties with respect to the risk factors and thus a hypothesis has been formulated on cardioprotective effects of hormone replacement therapy (HRT). The first observational studies have, indeed, showed HRT to decrease the risk of CVD in post‑menopausal women. Nevertheless, prospective studies provided unexpectedly controversial results (HERS, HERS II and WHI studies). Re-analysis of the WHI study confirmed that HRT did not decrease the risk of CVD; the incidence of CVD increased with age regardless of HRT. Some analyses showed that the risk of CVD is lower with monotherapy with estrogens than with combination HRT. There are important discrepancies between the individual observational studies that could explain the differences in cardioprotective properties of HRT. The present paper summarizes the main conclusions of the Consensus Statement of European Cardiologists and Gynaecologists from 2007. HRT improves quality of life and decreases vasomotor and urogenital symptoms of menopause, significantly decreases the risk of osteoporosis but is not indicated for primary or secondary prevention or for treatment of CVD. Consensus statement emphasises the importance of collaboration between a gynaecologist and a cardiologist in order to evaluate the woman’s cardiovascular risk and to make a correct decision about initiation of HRT. Nevertheless, further prospective randomised studies in peri-menopausal women are needed to obtain new “evidence‑based medicine“ results about the effects of HRT.

Keywords:
menopause – hormone replacement therapy – cardiovascular risk

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