Cardiovascular risk and hormone replacement therapy.

PURPOSE OF REVIEW

The purpose of this review is to summarize the studies in humans of the relationship between hormone replacement therapy and coronary heart disease and stroke.

RECENT FINDINGS

Randomized controlled trial evidence of the effect of hormone replacement therapy on coronary heart disease, stroke and atherosclerosis comes from nine individual secondary prevention randomized controlled trials, four individual primary prevention randomized controlled trials and a pooled analysis of 22 randomized controlled trials that had primary aims to examine noncardiovascular outcomes but which reported cardiovascular events by randomized groups. With the exception of one small primary prevention randomized controlled trial that found a weak protective effect of hormone replacement therapy on the progression of carotid artery intima media thickness, all other randomized controlled trials have found hormone replacement therapy either increases the risk of cardiovascular disease or has no effect.

SUMMARY

Randomized controlled trial evidence conducted in a variety of populations suggests that hormone replacement therapy is not protective against the risk of coronary heart disease, stroke or progression of atherosclerosis. The prevention of cardiovascular disease in women, as in men, should focus on implementing effective methods of reducing smoking, obesity, high blood pressure, dyslipidaemia and glucose intolerance.