Menopausal HT in Postmenopausal Women: Risks and Benefits
Menopausal HT in Postmenopausal Women: Risks and Benefits
Our objectives in this review were to examine the relevant menopausal hormone treatment (MHT) trials in postmenopausal women during the past 3 decades, provide an insight analysis of these studies from a clinical point of view, determine the efficacy and applicability of hormone therapy in the prevention of cardiovascular diseases, and provide suggestions on the use of MHT as a cardiovascular disease prophylaxis based on the available data. MHT may have a more complicated role in cardiovascular protection, and there is a need for further research to elucidate the dose and type of estrogen, its route of administration, the time of MHT initiation, and the preventive role of MHT in women's health.
Cardiovascular disease (CVD) is the largest single cause of death among women, accounting for one-third of all deaths worldwide. The average lifetime risk for CVD in women is high, approaching 1 in 2. Although the importance of coronary artery disease (CAD) and its prevention in women is gradually receiving increased physician and public attention, an online survey of primary care physicians, gynecologists, and cardiologists found that fewer than 20% of physicians were aware that more women than men die annually of CAD.
Five major differences exist between men and women with heart disease:
Menopausal hormone treatment (MHT) and its potential effects on CVD have been a point of controversy for some time. It is unknown whether the earlier initiation of MHT at the time of menopause would result in favorable CVD outcomes. Furthermore, it has not been established whether different hormonal preparations, lower doses, or alternate routes of administration would confer benefit or increased risk.
The goal in CVD is prevention, early detection, and modulation of risk. This article examines and summarizes the relevant MHT trials in postmenopausal women during the past 3 decades, provides an analysis of these studies from a clinical point of view, determines the efficacy and applicability of hormone therapy in the prevention of CVD, and provides suggestions on MHT use as a CVD prophylaxis based on the available data.
Abstract and Introduction
Abstract
Our objectives in this review were to examine the relevant menopausal hormone treatment (MHT) trials in postmenopausal women during the past 3 decades, provide an insight analysis of these studies from a clinical point of view, determine the efficacy and applicability of hormone therapy in the prevention of cardiovascular diseases, and provide suggestions on the use of MHT as a cardiovascular disease prophylaxis based on the available data. MHT may have a more complicated role in cardiovascular protection, and there is a need for further research to elucidate the dose and type of estrogen, its route of administration, the time of MHT initiation, and the preventive role of MHT in women's health.
Introduction
Cardiovascular disease (CVD) is the largest single cause of death among women, accounting for one-third of all deaths worldwide. The average lifetime risk for CVD in women is high, approaching 1 in 2. Although the importance of coronary artery disease (CAD) and its prevention in women is gradually receiving increased physician and public attention, an online survey of primary care physicians, gynecologists, and cardiologists found that fewer than 20% of physicians were aware that more women than men die annually of CAD.
Five major differences exist between men and women with heart disease:
Women tend to have a lower incidence of CAD than men at any given age. This trend holds for other CVD risk factors including left ventricular hypertrophy, hypercholesterolemia, and hypertension.
On average, women develop heart disease 7 to 10 years later than do men.
Atherosclerotic lesions in women contain significantly more cellular fibrous tissue compared with men.
High-density lipoproteins (HDL) tends to have a greater predictive value for cardiovascular events than low-density lipoproteins (LDL) or total cholesterol in women compared with men.
An elevated triglyceride concentration level in menopausal women is a strong independent risk factor for myocardial infarction (MI) and death when compared with cholesterol and smoking.
Menopausal hormone treatment (MHT) and its potential effects on CVD have been a point of controversy for some time. It is unknown whether the earlier initiation of MHT at the time of menopause would result in favorable CVD outcomes. Furthermore, it has not been established whether different hormonal preparations, lower doses, or alternate routes of administration would confer benefit or increased risk.
The goal in CVD is prevention, early detection, and modulation of risk. This article examines and summarizes the relevant MHT trials in postmenopausal women during the past 3 decades, provides an analysis of these studies from a clinical point of view, determines the efficacy and applicability of hormone therapy in the prevention of CVD, and provides suggestions on MHT use as a CVD prophylaxis based on the available data.