A new chance for hormone therapy in cardiological prophylaxis?

Among premenopausal women, coronary heart disease is extremely rare, even in high-risk populations, and the overall incidence of cardiovascular complications is much lower in premenopausal women than in men of similar age. After menopause, the reduced risk for coronary heart disease in women is gradually lost. The most plausible explanation for these observations is the protective effect of oestrogens. Observational studies have indicated that hormone therapy (HT) given at or after menopause is linked to substantial reduction in cardiovascular disease and its risk factors. In contrast, the randomized studies HERS (secondary prevention trial) and WHI (in preventing the new onset of cardiac events in previously healthy menopausal women) reported that HT did not reduce cardiovascular events and further demonstrated some trends towards an increased risk of cardiovascular events. The increased risk of coronary heart disease was surprising given that low-density cholesterol (cholesterol – LDL) and high-density cholesterol (cholesterol – HDL) levels increased. It may result from the effects of HRT on C-reactive protein levels and thromboembolism risk. In light of these results, what are the future directions in HT? • early initiation of hormone therapy, • lower doses of oestrogens, • route of oestrogen administration, • type of progestogens. The findings from the recent studies shed some light on understanding the differences between the various types of HT and about the safety of menopause hormones.