WOMEN AT CARDIAC RISK - IS HRT THE ROUTE TO MAINTAINING CARDIOVASCULAR HEALTH

Cardiovascular disease is the leading cause of death in women of postm enopausal age. Data from observational studies suggest that the risk o f coronary heart disease in postmenopausal women can be reduced by 30- 50% by estrogen replacement therapy. The protective effect of estrogen is multifactorial, affecting lipids, carbohydrate metabolism, hemosta sis, body-fat distribution and blood pressure. Although the unopposed use of estrogen is associated with an increased risk of endometrial ca ncer, this risk can be reduced or even neutralized by the addition of progestogen. The protection against cardiovascular disease provided by combined estrogen/progestogen treatment has been the subject of much debate. However, results from epidemiological studies, intervention tr ials and animal experiments now suggest that the addition of progestog en does not attenuate the beneficial effects of estrogen. While second ary prevention studies are needed to evaluate the various hormone regi mens, the use of combined estrogen/progestogen therapy can be supporte d. (C) 1997 International Federation of Gynecology and Obstetrics.