Volume 45, Issue 4 , Pages 287-293, December 2006
Hormone Therapy and Cardiovascular Disease
Article Outline
Summary
As in other Western countries, cardiovascular disease (CVD) is the leading cause of death among women in Taiwan, exceeding the mortality from cervical or breast cancer. Women generally present with CVD after menopause and later than men, since menopause-related estrogen deficiency has been considered to be associated with an increased risk for CVD. Thus, coronary artery diseases and stroke are the two main contributors of mortality among postmenopausal women. Observational studies have reported a reduction in coronary artery disease risk after hormone therapy (HT) ranging from 31-44%. However, recent randomized controlled trials that evaluated the effect of HT on primary and secondary CVD prevention have questioned the efficacy of HT, despite confirming the lipid-lowering effect of estrogen. However, a cluster of factors are responsible for the genesis and progression of CVD. Until we further evaluate their specific actions and how these different factors interact, the issue related to HT and cardiovascular risk will remain unsettled. Since these studies have contributed to our understanding of the benefits and risks associated with HT, HT use should be individualized after consideration of the condition of each postmenopausal patient. Ideally, the efficacy of different preparations and dosages of HT in postmenopausal women who are at risk of CVD, before atheromatous lesions have developed, should be investigated.
Key Words: cardiovascular disease , coronary artery disease , estrogen , hormone therapy
No full text is available. To read the body of this article, please view the PDF online.
References
- . Quality of life issues in the management of the menopause . In: Popkin D , Peddle L editor. Women's Health Today . New York: Parthenon; 1994;p. 271–290
- . Association of hormone replacement therapy with various cardiovascular risk factors in post-menopausal women . N Engl J Med . 1993;328:1069–1075
- . Estrogen replacement therapy and coronary heart disease: a quantitative assessment of the epidemiologic evidence . Prev Med . 1991;20:47–56
- . Reduction of cardiovascular disease-related mortality among postmenopausal women who use hormones: evidence from a national cohort . Am J Obstet Gynecol . 1991;164:489–494
- Hormone therapy to prevent disease and prolong life in postmenopausal women . Ann Intern Med . 1992;117:1016–1037
- . Hormonal replacement therapy and morbidity and mortality in a prospective study of postmenopausal women . Am J Public Health . 1995;85:1128–1132
- Post-menopausal estrogen and progestin use and the risk of cardiovascular disease . N Engl J Med . 1996;335:453–461
- Post-menopausal hormone therapy and mortality . N Engl J Med . 1997;336:1769–1775
- . A prospective, observational study of post-menopausal hormone therapy and primary prevention of cardiovascular disease . Ann Intern Med . 2000;133:933–941
- . Current use of unopposed estrogen and estrogen plus progestin and the risk of acute myocardial infarction among women with diabetes: the Northern California Kaiser Permanent Diabetes Registry, 1995–1998 . Circulation . 2003;107:43–48
- . Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial . JAMA . 2002;288:321–333
- . Effects of conjugated equine estrogen on postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial . JAMA . 2004;291:1701–1712
- . Conjugated equine estrogens and coronary heart disease . Arch Intern Med . 2006;166:357–365
- . Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group . JAMA . 1998;280:605–613
- . Menopause and risk of cardiovascular disease: the Framingham study . Ann Intern Med . 1976;85:447–452
- . Menopause and coronary heart disease. The Framingham study . Ann Intern Med . 1978;89:157–161
- . Influence of age and menopause on serum lipids and lipoproteins in healthy women . Atherosclerosis . 1993;98:83–90
- . The association between serum Lp(a) concentrations and angiographically assessed coronary atherosclerosis . Atherosclerosis . 1986;62:249–257
- . Lipoprotein(a) as a strong indicator for cerebrovascular disease . Stroke . 1986;17:942–945
- . Lipoprotein(a) modulation of endothelial cell surface fibrinolysis and its potential role in atherosclerosis . Nature . 1989;339:303–304
- . The relationship of Lp(a) to risk factors of coronary heart disease: initial results of the prospective epidemiological study on company employees in Westfalia . J Clin Chem Clin Biochem . 1984;22:591–596
- Bruschi F, Meschia M, Soma MR et al., Lp(a) levels in perimenopausal years: a population study [abstract]. Symposium on Women's Health in Menopause, September 1993, Milan, Italy.
- . Haemostatic variables and arterial thrombotic disease: epidemiological evidence . In: Seghatchian MJ , Samama MM , Hecker SP editor. Hypercoagulable States: Fundamental Aspects, Acquired Disorders, and Congenital Thrombophilis . Boca Raton, FL: CRC Press; 1996;p. 209–216
- . Menopausal status and haemostatic variables . Lancet . 1983;1:22–24
- . Population correlates of plasma fibrinogen and factor VII: putative cardiovascular risk factors . Atherosclerosis . 1991;91:191–205
- . Hemostatic factors according to menopausal status and use of hormone replacement therapy . Ann Epidemiol . 1992;2:445–455
- . Familial venous thrombophilia . In: Bloom AL , Forbes CD , Thomas DP , Tuddenham EGD editor. Haemostasis and Thrombosis . 3rd edition. Edinburgh: Churchill Livingstone; 1994;p. 1349–1360
- . Antithrombin III and arterial disease . Lancet . 1991;337:850–851
- . Influence of demographic factors on antithrombin III activity in a healthy population . Br J Haematol . 1993;84:476–480
- . Antithrombin III: associations with age, race, sex and cardiovascular disease risk factors . Thromb Haemost . 1994;72:551–556
- Protein C activity in healthy volunteers: influence of age, sex, smoking and oral contraceptives . Thromb Haemost . 1993;70:281–285
- . Correlation of plasma protein C levels with cardiovascular risk factors in middle-age adults: the ARIC Study . Thromb Haemost . 1993;70:762–767
- . Epidemiology of coagulation factors, inhibitors and activation markers: the third Glasgow MONICA survey I. Illustrative reference ranges by age, sex and hormone use . Br J Haematol . 1997;97:775–784
- . High plasminogen activator inhibitor and tissue plasminogen activator levels in plasma precede a first acute myocardial infarction in both men and women . Circulation . 1998;98:2241–2247
- . Predictive value of fibrinolytic factors in coronary heart disease . Scand J Clin Lab Invest . 1999;59:23–31
- . Relationship between plasminogen activator inhibitor activity and menopausal status . Fibrinolysis . 1990;4:233–236
- Association between increased estrogen status and increased fibrinolytic potential in the Framingham offspring study . Circulation . 1995;91:1952–1958
- . Effects of gonadectomy and hormonal replacement on rat hearts . Circ Res . 1987;61:12–16
- . Effect of menopause on left ventricular filling in 50-year-old women . Am J Cardiol . 1995;76:1093–1096
- Current estrogen-progestin and estrogen replacement therapy in elderly women: association with carotid atherosclerosis. CHS Collaborative Research Group. Cardiovascular Health Study . Ann Epidemiol . 1996;6:314–323
- . Associations of postmenopausal estrogen use with cardiovascular disease and its risk factors in older women. The CHS Collaborative Research Group . Circulation . 1993;88:2163–2171
- Effects of estrogen replacement on the progression of coronary artery atherosclerosis . N Engl J Med . 2000;343:522–529
- . Effect of oral postmenopausal hormone replacement on progression of atherosclerosis: a randomized, controlled trial . Arterioscler Thromb Vasc Biol . 2001;21:262–268
- Estrogen in the prevention of atherosclerosis. A randomized, double-blind, placebo-controlled trial . Ann Intern Med . 2001;135:939–953
- Effect of estrogen plus progestin on progression of carotid atherosclerosis in postmenopausal women with heart disease: HERS B-mode substudy . Arterioscler Thromb Vasc Biol . 2002;22:1692–1697
- Effects of hormone replacement therapy and antioxidant vitamin supplements on coronary atherosclerosis in postmenopausal women: a randomized controlled trial . JAMA . 2002;288:2432–2440
- Hormone therapy and the progression of coronary artery atherosclerosis in post-menopausal women . N Engl J Med . 2003;349:535–545
- Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II) . JAMA . 2002;288:49–57
- . A study of hormone replacement therapy in postmenopausal women with ischemic heart disease: the Papworth HRT atherosclerosis study . BJOG . 2002;109:1056–1062
- Oestrogen therapy for prevention of reinfarction in postmenopausal women: a randomized placebo controlled trial . Lancet . 2002;360:2001–2008
- . Randomized trial of effects of continuous combined HRT on markers of lipids and coagulation in women with acute coronary syndromes: WHISP Pilot Study . Eur Heart J . 2006;27:2046–2053
- . Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women . JAMA . 1995;273:199–208
- . Hormone replacement therapy, hormone levels, and lipoprotein cholesterol concentrations in elderly women . Am J Obstet Gynecol . 1996;174:897–902
- . Changes in the lipoprotein profile in postmenopausal women receiving hormone replacement therapy . J Reprod Med . 1998;43:568–574
- . Effects of hormone replacement therapy on cardiovascular risk factors in postmenopausal women . Fertil Steril . 1998;69:267–273
- . Comparison of transdermal and oral estrogen-progestin replacement therapy: effects on cardiovascular risk factors . Menopause . 2001;8:347–352
- . Short- and long-term effects of hormone replacement therapy on cardiovascular risk factors in postmenopausal women . Chang Gung Med J . 2001;24:431–439
- . Changes in hemostasis and lipid metabolism in postmenopausal women receiving hormone replacement therapy: effects of natural and synthetic progestogens . Taiwanese J Obstet Gynecol . 2004;43:80–87
- Association between increased estrogen status and increased fibrinolytic potential in the Framingham Offspring Study . Circulation . 1995;91:1952–1958
- The effect of estrogen replacement therapy with or without progestogen on the fibrinolytic system and coagulation inhibitors in post-menopausal status . Am J Obstet Gynecol . 1995;173:1849–1854
- Relation of hormone replacement therapy to measures of plasma fibrinolytic activity . Circulation . 1996;93:1970–1975
- . Paradoxical influence of estrogenic hormone on platelet-endothelial cell interactions . Thromb Res . 1994;74:577–594
PII: S1028-4559(09)60245-X
doi:10.1016/S1028-4559(09)60245-X
© 2006 Taiwan Association of Obstetric & Gynecology. Published by Elsevier Inc. All rights reserved.
Volume 45, Issue 4 , Pages 287-293, December 2006
