Last update:


Arch Hellen Med, 20(6), November-December 2003, 574-582


The role of hormone replacement therapy in cardiovascular disease:
Questions and answers

1Outpatient Lipid Clinic, Department of Internal Medicine
2Laboratory of Physiology, Medical School, University of Ioannina, Greece

The cardioprotective properties of hormone replacement therapy (HRT) have been attributed to their beneficial effects on lipid metabolism and on other risk factors such as blood pressure, endothelial function, plasma homocysteine and fibrinogen. Observational studies have shown that HRT (estrogen/progestin) significantly reduces coronary heart disease (CHD) risk in healthy postmenopausal women by up to 50%. Larger randomized studies are expected to surpass the limitations associated with these earlier studies and to illuminate a possible cardioprotective role of HRT in healthy postmenopausal women. The role of HRT in postmenopausal women with established CHD still remains controversial. Although earlier epidemiological studies yielded results favoring their cardioprotective properties, data from recent randomized studies such as the HERS and the ERA trial questioned the value of HRT in secondary prevention. Specifically, in both studies, HRT failed to reduce the overall incidence of cardiovascular events or to halt the progression of coronary atherosclerosis in postmenopausal women with established CHD. However, because of certain limitations within these trials there is a need for additional studies in order to establish the role of HRT in secondary CHD prevention. Selective estrogen receptor modulators (SERMs), such as raloxifene, have been introduced recently for the management of symptoms due to menopause. These drugs exert estrogenic actions on bone and lipid metabolism, while affecting uterus and breast tissues minimally. The results of ongoing studies using SERMs, such as the RUTH trial, in postmenopausal women at high risk of CHD are awaited with great interest.

Key words: Coronary heart disease, Ηormone replacement therapy, Μenopause, Primary prevention, Secondary prevention.

© Archives of Hellenic Medicine