Hormone replacement therapy and cardiovascular disease revisited.
Stevenson JC.
Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. j.stevenson@imperial.ac.uk.
Controversy still rages about whether hormone replacement therapy (HRT) confers cardiovascular benefit or harm. There is a wealth of biological evidence that estrogen has a beneficial effect, supporting a large body of epidemiological evidence demonstrating reduction in coronary events with HRT. A large randomized placebo-controlled clinical trial of preventive strategies for coronary heart disease (CHD) in postmenopausal women, the Women's Health Initiative (WHI), included HRT arms. The published preliminary findings of this trial showed a significant increase in coronary events, stroke, venous thromboembolism and breast cancer with estrogen-progestogen, leading to the conclusion that HRT was unsafe to use other than for short-term relief of menopausal symptoms. But subsequent publications of the more complete data from WHI have shown no significant increase in CHD, and a tendency to a reduction in those initiating HRT below age 60 years. This is important because other therapeutic strategies for the primary prevention of CHD, such as aspirin and statins, are not of proven benefit in women, in contrast to men. Subsequent WHI findings have not shown a clear increase in breast cancer, and any potential increase from HRT is similar to that seen with many lifestyle factors and other commonly used medications. The preliminary WHI results do not reflect accurately true benefits and risks, and HRT should remain a potential preventive treatment for CHD.
Please click on the required question.
- 1 HRT help me with the psychological difficulties that I am experiencing around?
- 2 HRT help my mental ability?
- 3 Can HRT reduce my chance of developing heart disease?
- 4 How does HRT protect against coronary heart disease?
- 5 If I am at particular risk of heart disease, can HRT still help?
- 6 Do progestogens taken in combination with oestrogen replacement therapy have an adverse effect on heart protection?
- 7 How long should HRT be taken to reduce the risk of heart disease?
- 8 Is there any evidence that HRT will protect my bones?
- 9 Would the dose (strength) of my HRT influence its ability to protect my bones?
- 10 Are there other treatments apart from HRT for osteoporosis?
- 11 Would HRT help my skin?
- 12 Can hormone replacement therapy cure all my menopausal symptoms?
- 13 How prevalent is cancer of the breast?
- 14 What factors influence the chance of breast cancer developing?
- 15 What is the relationship between HRT and breast cancer?
- 16 I have benign breast disease. Can I take HRT?
- 17 Does a history of breast cancer mean that HRT is absolutely contraindicated?
- 18 If I started HRT early (aged 30 to 45), does this influence my chance of developing breast cancer?
- 19 Does hormone replacement therapy increase the risks of cancer of the womb?
- 20 I have had endometrial cancer and now have menopausal problems. Can I take HRT?
- 21 Does HRT have a relationship to ovarian cancer?
- 22 How does HRT relate to a blood clot (DVT - deep venous thrombosis or pulmonary embolism)?
- 23 I have varicose veins. Can I take HRT?
- 24 Should HRT be discontinued before I have a major operation or leg surgery?
- 25 Does HRT increase life-expectancy?
- 26 I am still seeing periods. Could HRT have any benefits for me?
- 27 I have been told that I have fibroids. Can I take HRT?
- 28 What happens if I decide not to take HRT?
- 29 Doctors seem to promote HRT but the media cause me anxiety. Who is right?
- 30 Support Groups.
