Hormone replacement therapy and cardiovascular diseases

Women enjoy a lower incidence of cardiovascular events than men, but this advantage is lost during the postmenopause. Epidemiological studies suggested that estrogen therapy for postmenopausal symptoms may exert protective effects against coronary heart disease (CHD); however, prospective, randomized clinical studies do not confirm cardiovascular protective effects of long-term treatment with estrogen/gestagen combinations. Instead, the risks for CHD, stroke, pulmonary embolism, and breast cancer increased, whereas the risks for hip fracture and colon carcinoma decreased. Phytoestrogens and synthetic steroids with estrogen action have not been shown to protect against cardiovascular disease, and raloxifene, a selective estrogen receptor modulator (SERM), has not demonstrated protection against CHD. Hormone replacement therapy in the postmenopause therefore cannot be recommended for cardiovascular risk reduction, but should only be initiated for severe postmenopausal symptoms.