SymposiumHormone Replacement Therapy and Coronary Heart Disease in Women: A Review of the Evidence
Section snippets
Early Studies/Observational Studies
The role of hormone replacement therapy (HRT) in prevention of CHD was first considered when early epidemiological studies indicated a possible protective role of estrogen. Premenopausal women with intact ovaries presented with CHD 10 years later than men of the same age, 6 whereas women who underwent bilateral oophorectomy had CHD rates comparable with those of men of the same age. 7 Another study showed a 2% decrease in cardiovascular mortality rate for every year’s delay in development of
Clinical Trials
The first randomized trial to assess the role of HRT on secondary prevention of CHD was actually conducted in men with prior history of Q-wave MI, who were randomized to receive estrogen or placebo. 19 The study was prematurely discontinued because of a significant increase in MI as well as increase in thromboembolic disease in the group receiving estrogen.
The Postmenopausal Estrogen/Progestin Interventions (PEPI) Trial was the first large randomized trial in women to look at the effect of HRT
Other Hormones and CHD
There has been increasing interest in selective estrogen receptor modulators (SERMs) as a substitute for estrogen. The SERMs role in CHD is not yet well defined. Several ongoing trials are examining the potential relationship between SERM and CHD.
In the Breast Cancer Prevention Trial (BCPT), 13,388 women >60 years old with high risk for breast cancer were randomized to tamoxifen or placebo. 25 The primary outcome of the study was breast cancer prevention; CHD events were secondary outcomes of
Discussion
The beneficial role of estrogen in CHD has been considered for many years, but recent studies bring forth many unanswered questions. Based on early epidemiological studies, it seemed logical to conclude that HRT has a protective role for women against CHD. Subsequent observational studies have supported this hypothesis. However, limitations and flaws intrinsic to observational studies may have caused significant bias and thus affected interpretation of the data. In observational studies, such
Update
As this article was being prepared for publication, reports from both Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II) 29 and Women’s Health Initiative (WHI) 30 were published. Both studies concluded that HRT has no role in primary or secondary prevention of CHD in women.
HERS II was designed to determine whether the CHD risk reduction observed in the later years of HERS will persist over long-term use of HRT. The study followed HERS women who continued on HRT for an additional
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Activation of G protein-coupled estrogen receptor fine-tunes age-related decreased vascular activities in the aortae of female and male rats
2022, SteroidsCitation Excerpt :The incidence of CVD in women lags behind men about 10 years [1], but tends to equalize after menopause, likely related to declining estrogen levels. However, hormone replacement therapy was shown to be ineffective with regard to cardiovascular protection, causing an increased risk of heart attack and stroke across a wide range of ages (50–79 years) [2,3]. In women >65 years of age, with the highest mortality rate, hormone replacement therapy is associated with greater CVD risk [4,5].
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2014, Journal of Steroid Biochemistry and Molecular BiologyCitation Excerpt :Therefore hormone replacement therapy (HRT) was practiced for more than half a century but recently published clinical studies have questioned its safety. The 2 HERS studies questioned the safety of HRT in the cardiovascular system (for review see [1,2]). In the estrogen/progestin arm of the large Women's Health Initiative (WHI) it was shown that intake of a combination preparation containing conjugated estrogens and medroxyprogesterone acetate taken for a period of more than 8 years increased the risk for the development of mammary cancer.
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