Abstract
Coronary artery disease (CAD) is the number one cause of death and disability in the Western world. Its incidence increases with age and women present with symptomatic CAD on average about ten years later than men. Rationale for using hormone replacement therapy (HRT) is based on its effects on vasoreactivity, progression of atherosclerosis, lipids and lipoproteins, effects on the haemostatic system and impaired glucose tolerance. However, unopposed oestrogen might be related to an increased risk of endometrial cancer. The overall beneficial effect of HRT on cardiovascular diseases is derived from prospective cohort studies. The Heart and Estrogen/progestin Replacement Study showed no beneficial effect of HRT on cardiovascular morbidity and mortality. However, there are uncertainties about the duration and optimal type of HRT regimen. Ongoing trials addressing similar questions are not expected to be published within the next five years. The Women's Hormone Intervention Secondary Prevention (WHISP) pilot study addresses the effect of a novel HRT regimen on lipid and haemostatic risk markers of heart disease and may pave the way for a large trial evaluating the effect of HRT on morbidity and mortality.
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