The role of hormone replacement therapy (HRT) for the prevention of cardiac
disease is contentious. In this review the epidemiological evidence for the role
of HRT in primary and secondary prevention of cardiac disease is assessed.
Although current studies suggest very little role for HRT in women with
established cardiac disease, its use in the ‘healthy
woman’ without vascular disease until recently was not clear. HRT for
the sole purpose of prevention of cardiac disease is now not indicated.
MoscaLMansonJESutherlandSELangerRDManolioTBarrett-ConnorE.Cardiovascular disease in women. A statement for healthcare
professionals from the American Heart Association.
Circulation1997;
96:2468–2482.
2.
EakerEDChesebroJHSacksFMWengerNKWhisnantJPWinstonM.Cardiovascular disease in women.
Circulation1993;
88:1999–2009.
3.
BristerSTurekMAbramsonBLArthurHBlackwellMBondySCanadian Cardiovascular Society. Women and ischaemic heart
disease: CCS 2000 Consensus Conference. Can J
Cardiol2001; 17 [Suppl
D]:2D–13D.
4.
WilliamsJKAdamsMRKlopfensteinHS.Oestrogen modulates responses of atherosclerotic coronary
arteries. Circulation1990;
81:1680–1687.
5.
WilcoxJGHatchIEGentzscheinEStanczykFZLoboRA.Endothelin levels decrease after oral and non-oral oestrogen in
postmenopausal women with increased cardiovascular risk
factors. Fert Steril1997;
67:273–277.
6.
CollinsP.Vascular aspects of oestrogen. Maturitas1996;
23:217–226.
7.
CollinsPRosanoGMCSarrelPMUlrichLAdamopoulosSBealeCM17 β-estradiol attenuates acetylcholine-induced
coronary arterial constriction in women but not men with coronary heart
disease. Circulation1995;
92:24–30.
8.
Barrett-ConnorELaaskoM.Ischemic heart disease risk in postmenopausal women: Effects of
estrogen use on glucose and insulin levels.
Arteriosclerosis1990;
10:531–534.
9.
The writing group for the PEPI
trial. Effects of estrogen or
estrogen/progestin regimens on heart disease risk factors in
postmenopausal women. The postmenopausal estrogen/progestin
interventions (PEPI) trial. JAMA1995;
273:199–208.
10.
AdamsMRKaplanJRManuckSBKoritnikDRParksJSWolfeMSInhibition of coronary artery atherosclerosis by
17β-estradiol in ovariectomized monkeys.
Arteriosclerosis1990;
10:1051–1057.
11.
HulleySGradyDBushTLFurbergCDHerringtonDMRiggsBRandomized trial of estrogen plus progestin for secondary
prevention of coronary heart disease in postmenopausal
women. JAMA1998;
280:605–613.
12.
HerringtonDMFongJSemposCTLackDMSchrottHGRautaharjuPMComparison of the Heart and Estrogen/Progestin
Replacement Study (HERS) cohort with women with coronary disease from the
National Health and Nutrition Examination Survey III (NHANES
III). Am Heart J1998;136:115–124.
13.
GradyDWegnerNKHerringtonDMKhanSFurbergCDHunninghakeDPostmenopausal hormone therapy increases risk for venous
thromboembolic disease: The Heart and Estrogen/Progestin
Replacement Study. Ann Intern Med2000;
132:689–696.
14.
DalyEVesseyMPHawkinsMMCarsonJLGoughPMarshS.Risk of venous thrombo-embolism in users of hormone replacement
therapy. Lancet1996;
348:977–980.
15.
JickHDerbyLEMyersMWVasilakisCNewtonKM.Risk of hospital admission for idiopathic venous thrombo-embolism
among users of postmenopausal estrogens. Lancet1996;
348:981–983.
16.
GrodsteinFStampferMJGolhaberSZMansonJEColditzGASpeizerFEProspective study of exogenous hormones and risk of pulmonary
embolism in women. Lancet1996;
348:983–987.
17.
HerringtonDMVittinghoffELinFFongJHarrisFHunninghakeDBStatin therapy, cardiovascular events, and total mortality in the
Heart and Estrogen/Progestin Replacement Study
(HERS). Circ2002;
105:2962–2967.
18.
BraunwaldEAntmanEMBeasleyJWCaliffRMCheitlinMDHochmanJSACC/AHA guidelines for the management of patients with
unstable angina and non-ST-segment elevation myocardial
infarction. J Am Coll Cardiol2000;
36:970–1062.
19.
GradyDHerringtonDBittnerVBlumenthalRDavidsonMHlatkyMFor the HERS Research Group. Cardiovascular disease outcomes
during 6.8 years of hormone therapy: Heart and Estrogen/progestin
Replacement Study follow-up (HERS II). JAMA2002;
288:49–57.
20.
HerringtonDMReboussinDMBrosnihanKBSharpPCShumakerSSSnyderTEEffects of estrogen replacement on the progression of coronary
artery atherosclerosis. N Engl J Med2000;
343:522–529.
21.
AbramsonBL.Hormone replacement and cardiac prevention.
Circulation2000;
101:E223E–224.
22.
RossouwJEFinneganLPHarlanWRPinnVWCliffordCMcGowanJA.The evolution of the Women's Health Initiative:
Perspectives from the NIH. J Am Med
Women's Association1995;
50:50–55.
23.
The Women's Health Initiative
Group. Design of the women's health
initiative clinical trial and observational study.
Controlled Clin Trials1998;
19:61–109.
24.
Writing Group for the Women's
Health Initiative Investigators. Risks and benefits
of estrogen plus progestin in healthy postmenopausal women: Principal
results from the Women's Health Initiative randomized controlled
trial. JAMA2002;
288:321–337.
25.
BushTL.Non-contraceptive estrogen use and risk of cardiovascular
disease: An overview and critique of the literature. In:
KorenmanSG (editor) The Menopause. Biological and clinical
consequences of ovarian failure: Evolution and management.
Norwell, Massachusetts:
Sereno Symposia; 1990;
211–223.
26.
StampferMJColditzGA.Estrogen replacement therapy and coronary heart disease: A
quantitative assessment of the epidemiological evidence.
Prev Med1991;
20:47–63.
27.
GradyDRubinSMPetittiDBFoxCSBlackDEttingerBHormone therapy to prevent disease and prolong life in
postmenopausal women. Ann Intern Med1992;
117:1016–1037.
28.
CauleyJASeeleyDGBrownerWSEnsrudKKullerLHLipschutzRCEstrogen replacement therapy and mortality among older
women. Arch Intern Med1997;
157:2181–2187.
29.
FalkebornMPerssonIAdamiHBergstromREakerELithellHThe risk of acute myocardial infarction after estrogen and
estrogen-progestogen replacement. Br J Obstet
Gynaecol1992;
99:821–828.
30.
FolsomARMinkPJSellersTAHongCZhengWPotterJD.Hormonal replacement therapy and morbidity and mortality in a
prospective study of postmenopausal women. Am J
Public Health1995;
85:1128–1132.
31.
LaffertyFWFiskeME.Postmenopausal estrogen replacement: A long-term cohort
study. Am J Med1994;
97:66–77.
32.
SchairerCAdamiHHooverRPerssonI.Cause-specific mortality in women receiving hormone replacement
therapy. Epidemiology1997;
8:59–65.
33.
SouranderLRajalaTRaihaIMakinenJErkkolaRHeleniusH.Cardiovascular and cancer morbidity and mortality and sudden
cardiac death in postmenopausal women on estrogen replacement therapy
(ERT). Lancet1998;
352:1965–1969.
34.
SturgeonSRSchairerCBrintonLAPearsonTHooverRN.Evidence of a healthy estrogen user survivor
effect. Epidemiology1995;
6:227–231.
35.
GrodsteinFStampferMJColditzGAWillettWCMansonJEJoffeMPostmenopausal hormone therapy and mortality.
N Engl J Med1997;
336:1769–1775.
36.
AvilaMHWalkerAMJickH.Use of replacement estrogens and the risk of myocardial
infarction. Epidemiology1990;
1:128–133.
37.
BushTLBarrett-ConnorECowanLDCriquiMHWallaceRBSuchindranCMCardiovascular mortality and non-contraceptive use of estrogen in
women: Results from the Lipid Research Clinics Program Follow-up
Study. Circulation1987;
75:1102–1109.
38.
CriquiMHSuarezLBarrett-ConnorEMcPhillipsJWingardDLGarlandC.Postmenopausal estrogen use and mortality.
Am J Epidemiol1988;
128:606–614.
39.
GrodsteinFStampferMJMansonJEColditzGAWillettWCRosnerBPostmenopausal estogen and progestin use and the risk of
cardiovascular disease. N Engl J Med1996;
335:453–461.
40.
HendersonBEPaganini-HillARossRK.Decreased mortality in users of estrogen replacement
therapy. Arch Intern Med1991;
151:75–78.
41.
NachtigallLENachtigallRHNachtigallRDBeckmanME.Estrogen replacement therapy II: A prospective study in
relationship to carcinoma and cardiovascular and metabolic
problems. Obstet Gynecol1979;
54:74–79.
42.
WilsonPWGarrisonRJCastelliWP.Postmenopausal estrogen use, cigarette smoking, and
cardiovascular morbidity in women over 50: The Framingham
study. N Engl J Med1985;
313:1038–1043.
43.
WolfPHMadansJHFinucaneFFHigginsMKleinmanJC.Reduction of cardiovascular disease-related mortality among
postmenopausal women who use hormones: Evidence from a national
cohort. Am J Obstet Gynaecol1991;
164:489–494.
44.
AdamsMRRegisterTCGoldenDLWagnerJDWilliamsJK.Medoxyprogesterone acetate antagonizes inhibitory effects of
conjugated equine estrogens on coronary artery
atheroscerosis. Arterioscler Thromb Vasc Biol1997;
17:217–221.
45.
MillerVMVanhouttePM.Progestrone and modulation of endothelium-dependent responses in
canine coronary arteries. Am J Physiol1991;
261:1022–1027.
46.
SchroderJDorenMSchneiderBOettelM.Are the antioxidative effects of 17 β-estradiol
modified by concomitant administration of a
progestin? Maturitas1996;
25:133–139.
47.
Barrett-ConnorEGradyDSashegyiAAndersonPWCoxDAHoszowskiKRautaharjuPHarperKD, For the MORE Investigators. Raloxifene and
cardiovascular events in osteoporotic postmenopausal women. Four-year
results from the MORE (Multiple Outcomes of Raloxifene Evaluation)
Randomized Trial. JAMA2002;
287:847–857.
48.
MoscaLGrundySMJudelsonDKingKLimacherMOparilSGuide to preventive cardiology for women.
Circulation1999;
99:2480–2484.
