The metabolic issues of hormone replacement therapy

Abstract

summary

The probability that a menopausal woman will develop coronary heart disease is 46%, and 20% for stroke. Recently, the hormone replacement therapy paradigm on the balance of benefits and harm has been affected by puzzling information from several major randomised clinical trials showing no cardiovascular benefit. While studies may have shortcomings, clinical interpretation is also influenced by the fact that we are on a steep learning curve in pharmacoepidemiology and pharmacogenetics. This points to the clinical relevance of new findings from clinical studies on biomarkers, and from in vitro and animal research models. The research priority has been to identify the mechanisms and markers of risk and this potentially represents a significant scientific advance. It can lead to the identification of women who will benefit from hormone replacement therapy by preventing coronary heart disease and also improve testing of hormones that do not trigger any pro-thrombotic activity. Despite the pessimistic findings of recent epidemiological studies, it is biologically and metabolically plausible that in the years to come different hormonal treatments and use of new biomarkers will lead to therapies being individually targeted to benefit the cardiovascular system.