Hormone replacement therapy and cardioprotection: The end of the tale?

Research output: Contribution to journalArticle

Abstract

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women after the age of 50 years in most developed countries. Estrogen deficiency plays a key role in causing CVD in women. Apart from the direct effect of ovarian hormones on the vessel wall, cessation of ovarian function and the consequent reduction of sex steroid hormone levels have important metabolic and pathological implications that negatively influence the cardiovascular system. Therefore, the increased incidence of CVD observed in women after menopause should be considered on a multifactorial basis. Data available for the effects of ERT and HRT in the primary prevention of CVD are mainly observational. However, despite limitations related to this kind of study, it must be noted that their results consistently show a reduction in cardiovascular events in hormone users. Meta-analysis of epidemiological studies found that women who had ever used estrogens had a 34% overall reduction in the relatrive risk of cardiovascular events compared to those who had never used hormones. Most of the early epidemiological studies were conducted using unopposed estrogen replacement therapy. The number of studies evaluating the effects of estrogen-progestin replacement therapy is limited. Recently, the estrogen-progestin arm of the Women's Health Initiative (WHI) study has been stopped because of an increased incidence of breast cancer, and too early on to give any insight into possible cardiovascular effects. Comments on the cardiovascular effects of HRT from the results of the WHI study are therefore not warranted, as the study did not continue for a duration long enough to enable a calculation of cardiovascular end points. The WHI study included only one single type of estrogen-progestin association; whether different estrogen-progestin combinations, more commonly used outside the United States, may have a different effect is still a matter of speculation. A major difference between observational and randomized studies on the effect of ovarian hormones on cardiovascular function is the time of HRT initiation since menopause, which is significantly shorter in obersvational studies. In conclusion, the average 35-50% risk reduction in CVD with HRT in primary prevention in postmenopausal women is based on nonrandomized observational data.

Original languageEnglish
Pages (from-to)351-357
Number of pages7
JournalAnnals of the New York Academy of Sciences
Volume997
DOIs
Publication statusPublished - 2003

Fingerprint

Hormone Replacement Therapy
Estrogens
Cardiovascular Diseases
Hormones
Women's Health
Progestins
Estrogen Replacement Therapy
Primary Prevention
Menopause
Epidemiologic Studies
Incidence
Gonadal Steroid Hormones
Risk Reduction Behavior
Cardiovascular System
Developed Countries
Cardiovascular system
Observational Studies
Meta-Analysis
Estrogen
Breast Neoplasms

Keywords

  • Cardioprotection
  • Cardiovascular disease
  • Estrogen replacement therapy (ERT)
  • Hormone replacement therapy (HRT)
  • Postmenopausal women
  • Venous thromboembolism

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Hormone replacement therapy and cardioprotection : The end of the tale? / Rosano, Giuseppe M C; Vitale, Cristiana; Silvestri, Antonello; Fini, Massimo.

In: Annals of the New York Academy of Sciences, Vol. 997, 2003, p. 351-357.

Research output: Contribution to journalArticle

@article{5450c93a0026475586ccc6dbd810ab69,
title = "Hormone replacement therapy and cardioprotection: The end of the tale?",
abstract = "Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women after the age of 50 years in most developed countries. Estrogen deficiency plays a key role in causing CVD in women. Apart from the direct effect of ovarian hormones on the vessel wall, cessation of ovarian function and the consequent reduction of sex steroid hormone levels have important metabolic and pathological implications that negatively influence the cardiovascular system. Therefore, the increased incidence of CVD observed in women after menopause should be considered on a multifactorial basis. Data available for the effects of ERT and HRT in the primary prevention of CVD are mainly observational. However, despite limitations related to this kind of study, it must be noted that their results consistently show a reduction in cardiovascular events in hormone users. Meta-analysis of epidemiological studies found that women who had ever used estrogens had a 34{\%} overall reduction in the relatrive risk of cardiovascular events compared to those who had never used hormones. Most of the early epidemiological studies were conducted using unopposed estrogen replacement therapy. The number of studies evaluating the effects of estrogen-progestin replacement therapy is limited. Recently, the estrogen-progestin arm of the Women's Health Initiative (WHI) study has been stopped because of an increased incidence of breast cancer, and too early on to give any insight into possible cardiovascular effects. Comments on the cardiovascular effects of HRT from the results of the WHI study are therefore not warranted, as the study did not continue for a duration long enough to enable a calculation of cardiovascular end points. The WHI study included only one single type of estrogen-progestin association; whether different estrogen-progestin combinations, more commonly used outside the United States, may have a different effect is still a matter of speculation. A major difference between observational and randomized studies on the effect of ovarian hormones on cardiovascular function is the time of HRT initiation since menopause, which is significantly shorter in obersvational studies. In conclusion, the average 35-50{\%} risk reduction in CVD with HRT in primary prevention in postmenopausal women is based on nonrandomized observational data.",
keywords = "Cardioprotection, Cardiovascular disease, Estrogen replacement therapy (ERT), Hormone replacement therapy (HRT), Postmenopausal women, Venous thromboembolism",
author = "Rosano, {Giuseppe M C} and Cristiana Vitale and Antonello Silvestri and Massimo Fini",
year = "2003",
doi = "10.1196/annals.1290.038",
language = "English",
volume = "997",
pages = "351--357",
journal = "Annals of the New York Academy of Sciences",
issn = "0077-8923",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Hormone replacement therapy and cardioprotection

T2 - The end of the tale?

AU - Rosano, Giuseppe M C

AU - Vitale, Cristiana

AU - Silvestri, Antonello

AU - Fini, Massimo

PY - 2003

Y1 - 2003

N2 - Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women after the age of 50 years in most developed countries. Estrogen deficiency plays a key role in causing CVD in women. Apart from the direct effect of ovarian hormones on the vessel wall, cessation of ovarian function and the consequent reduction of sex steroid hormone levels have important metabolic and pathological implications that negatively influence the cardiovascular system. Therefore, the increased incidence of CVD observed in women after menopause should be considered on a multifactorial basis. Data available for the effects of ERT and HRT in the primary prevention of CVD are mainly observational. However, despite limitations related to this kind of study, it must be noted that their results consistently show a reduction in cardiovascular events in hormone users. Meta-analysis of epidemiological studies found that women who had ever used estrogens had a 34% overall reduction in the relatrive risk of cardiovascular events compared to those who had never used hormones. Most of the early epidemiological studies were conducted using unopposed estrogen replacement therapy. The number of studies evaluating the effects of estrogen-progestin replacement therapy is limited. Recently, the estrogen-progestin arm of the Women's Health Initiative (WHI) study has been stopped because of an increased incidence of breast cancer, and too early on to give any insight into possible cardiovascular effects. Comments on the cardiovascular effects of HRT from the results of the WHI study are therefore not warranted, as the study did not continue for a duration long enough to enable a calculation of cardiovascular end points. The WHI study included only one single type of estrogen-progestin association; whether different estrogen-progestin combinations, more commonly used outside the United States, may have a different effect is still a matter of speculation. A major difference between observational and randomized studies on the effect of ovarian hormones on cardiovascular function is the time of HRT initiation since menopause, which is significantly shorter in obersvational studies. In conclusion, the average 35-50% risk reduction in CVD with HRT in primary prevention in postmenopausal women is based on nonrandomized observational data.

AB - Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women after the age of 50 years in most developed countries. Estrogen deficiency plays a key role in causing CVD in women. Apart from the direct effect of ovarian hormones on the vessel wall, cessation of ovarian function and the consequent reduction of sex steroid hormone levels have important metabolic and pathological implications that negatively influence the cardiovascular system. Therefore, the increased incidence of CVD observed in women after menopause should be considered on a multifactorial basis. Data available for the effects of ERT and HRT in the primary prevention of CVD are mainly observational. However, despite limitations related to this kind of study, it must be noted that their results consistently show a reduction in cardiovascular events in hormone users. Meta-analysis of epidemiological studies found that women who had ever used estrogens had a 34% overall reduction in the relatrive risk of cardiovascular events compared to those who had never used hormones. Most of the early epidemiological studies were conducted using unopposed estrogen replacement therapy. The number of studies evaluating the effects of estrogen-progestin replacement therapy is limited. Recently, the estrogen-progestin arm of the Women's Health Initiative (WHI) study has been stopped because of an increased incidence of breast cancer, and too early on to give any insight into possible cardiovascular effects. Comments on the cardiovascular effects of HRT from the results of the WHI study are therefore not warranted, as the study did not continue for a duration long enough to enable a calculation of cardiovascular end points. The WHI study included only one single type of estrogen-progestin association; whether different estrogen-progestin combinations, more commonly used outside the United States, may have a different effect is still a matter of speculation. A major difference between observational and randomized studies on the effect of ovarian hormones on cardiovascular function is the time of HRT initiation since menopause, which is significantly shorter in obersvational studies. In conclusion, the average 35-50% risk reduction in CVD with HRT in primary prevention in postmenopausal women is based on nonrandomized observational data.

KW - Cardioprotection

KW - Cardiovascular disease

KW - Estrogen replacement therapy (ERT)

KW - Hormone replacement therapy (HRT)

KW - Postmenopausal women

KW - Venous thromboembolism

UR - http://www.scopus.com/inward/record.url?scp=0642272523&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0642272523&partnerID=8YFLogxK

U2 - 10.1196/annals.1290.038

DO - 10.1196/annals.1290.038

M3 - Article

C2 - 14644842

AN - SCOPUS:0642272523

VL - 997

SP - 351

EP - 357

JO - Annals of the New York Academy of Sciences

JF - Annals of the New York Academy of Sciences

SN - 0077-8923

ER -