Hormone replacement therapy and cardioprotection: basic concepts and clinical considerations.

A large body of epidemiological evidence shows that estrogen use after the menopause reduces the incidence of cardiovascular disease up to 50%. The use of progestin as co-medication in HRT appears not to attenuate the cardioprotective effects of estrogen. Menopause-related changes in metabolic cardiovascular risk factors are identifiable, as are HRT-related changes in these factors. Estrogens may act in a gender-specific way on vascular endothelial cells and other components of the vessel wall enhancing the synthesis and release of NO and other vasodilators and by inhibiting the synthesis and release of vasoconstricting agents, thus favoring vasodilation. Angiographic studies demonstrated in postmenopausal women with ischemic heart disease a reduction in coronary stenosis by estrogen monotherapy. Several studies, including the PEPI-trial, failed to demonstrate any major effect of HRT on blood pressure. The information on HRT and cardioprotection which is available so far is very promising and merits recommending HRT not only in healthy women but also in women with cardiovascular disease as well as in women with increased risk for this disease.