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Hormone replacement therapy and cardiovascular disease - is the issue closed?

ESC Congress 2010

Risk Factors, Prevention, Rehabilitation, Sports Cardiology

How hormone therapy (HT) in postmenopausal women should be tackled from a cardiovascular point of view continues to be an issue. The aim of this symposium organized by the EACPR (European Association of Cardiovascular Prevention and Rehabilitation) under the ESC, was to critically appraise the different aspects of the evidence.

Dr. Arnal, France, explained the complex vascular and inflammatory effects of estrogen related to development of CVD and emphasized the importance of timing, based on animal studies showing that the effect of estrogen on vessel wall depends on whether there are already fatty streaks or plaque developed, with beneficial effect on the healthy vessel and deleterious effect on the disrupted vessel wall.

Dr. Stramba-Badiale, Italy, went on to give a historic overview of the observational and intervention studies in the area and summarized the current recommendations, including the consensus document from European cardiologists and gynaecologists published in 2007 stating that HT should not be given for primary or secondary prevention of CVD in older women and in treating perimenopausal women for menopausal symptoms, the benefits should be weighed against the potential risks of HT.

Dr. Stevenson, UK, then gave a provocative talk with a critical view on the Women’s Health Initiative (WHI) results, emphasizing also the timing of treatment and the difference between results from WHI and larger metaanalysis. Dr Stevenson concluded that current evidence is in favour of treating selected groups of high risk women with HT, not only to alleviate symptoms but more importantly to reduce risk burden.

Finally, Dr. Schenck-Gustafsson, Sweden, presented a moderated view with emphasis on the following guidelines: in selected women with hormone withdrawal symptoms, HT is a treatment option after weighing the cost benefits.

The symposium was very clear in concluding that in elderly postmenopausal women, HT poses a CVD risk, but also highlighted very illustratively why HT in younger postmenopausal women from a CVD point of view is still not settled. The WHI was first published in 2002 and debate on how results should be interpreted continues. Without new studies with hard endpoints – and none seem on the way - this is not likely to be settled, and the prudent attitude would be to follow the recommendations: reduce CVD risk in women by lifestyle measures and treat selected women with withdrawal symptoms with HT for a limited period.




Hormone replacement therapy and cardiovascular disease - is the issue closed?

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.