Menopausal hormone therapy for cardiovascular protection--unfulfilled expectations.

Despite biologically plausible mechanisms of benefit and data from observational studies suggesting cardioprotection from menopausal hormone therapy, the results of randomized clinical trials in both healthy women and women with established coronary heart disease failed to show benefit and indeed imparted some harm. In 2009, menopausal hormone therapy is not indicated for the primary prevention of coronary heart disease or of cardiovascular disease. Prevention of cardiovascular disease in women should be addressed by the aggressive identification and modification of established cardiovascular risk factors. Much remains unknown about the mechanisms of menopausal hormone therapy action and the issue of whether there is a therapeutic window of opportunity for its use.