Women at cardiac risk: is HRT the route to maintaining cardiovascular health?

Cardiovascular disease is the leading cause of death in women of postmenopausal age. Data from observational studies suggest that the risk of coronary heart disease in postmenopausal women can be reduced by 30-50% by estrogen replacement therapy. The protective effect of estrogen is multifactorial, affecting lipids, carbohydrate metabolism, hemostasis, body-fat distribution and blood pressure. Although the unopposed use of estrogen is associated with an increased risk of endometrial cancer, this risk can be reduced or even neutralized by the addition of progestogen. The protection against cardiovascular disease provided by combined estrogen/progestogen treatment has been the subject of much debate. However, results from epidemiological studies, intervention trials and animal experiments now suggest that the addition of progestogen does not attenuate the beneficial effects of estrogen. While secondary prevention studies are needed to evaluate the various hormone regimens, the use of combined estrogen/progestogen therapy can be supported.