Hormone therapy and cardiovascular risk: Why the new focus on perimenopausal women?

摘要

PURPOSE: To review the reasons hormone therapy (HT) is not currently recommended for cardiovascular disease (CVD) prevention in women and to explore preliminary evidence indicating that the timing of HT in relation to menopause onset may impact cardiovascular (CV) outcomes. EPIDEMIOLOGY: Every year, CVD kills 4 times more women than do breast and lung cancer combined. Although men develop CVD earlier than women, more women than men eventually will die from the disease. Almost two thirds of women who die suddenly due to CVD have no previous symptoms. REVIEW SUMMARY: The Women's Health Initiative (WHI) study and the Heart and Estrogen/Progestin Study (HERS) have led to strong recommendations against the use of HT for the prevention of chronic diseases. Instead, HT is offered only in the smallest doses and for the shortest durations to manage specific symptoms of menopause or to reduce the risk of osteoporosis. However, new data indicate that estrogen deficiency may be a potent risk factor for coronary artery disease in young, premenopausal women and that HT may be beneficial in perimenopausal women. One or these new studies was a subgroup analysis of WHI and the other was a follow-up on the large prospective Nurses Health Study. Tnese results together with those of the Women's Ischemia Syndrome Evaluation studies show that the timing of HT in relation to menopause onset may influence CV risk; prospective randomized studies are under way to validate these findings and explore the potential mechanisms. TYPE OF AVAILABLE EVIDENCE: Nationally recognized treatment guidelines, randomized controlled studies, systematic reviews. GRADE OF AVAILABLE EVIDENCE: Fair to good. CONCLUSION: Coronary heart disease remains the leading cause of death for American women. Although HT is not indicated for use in preventing CVD in women, ongoing research is evaluating the hypothesis that a subset of younger perimenopausal women may derive a CV benefit from HT.