A REVIEW OF THE ASSOCIATION OF ESTROGENS AND PROGESTINS WITH CARDIOVASCULAR-DISEASE IN POSTMENOPAUSAL WOMEN

The purpose of this article was to review, with special attention to t he hypothesized mechanisms of atherosclerosis and thrombosis, the lite rature on the association of estrogens and progestins with cardiovascu lar disease. The data sources included recent reviews and their citati ons as well as literature searches of Medline. For coronary heart dise ase, we relied on a recent meta-analysis; for the lipid effects of est rogens and progestins, we refer to recent reviews and studies; for str oke, we identified all cohort and case-control studies; and for the ef fects of hormones on coagulation factors, we identified all relevant s tudies. The lipid effects of estrogens in postmenopausal women probabl y prevent atherosclerosis, and we would expect long duration o f use r ather than current use to provide the greatest benefit. Few epidemiolo gic studies have, however, assessed duration of estrogen use. High dos es of estrogens are likely to be thrombogenic during current use, and it is possible that even moderate doses may increase the risk of clott ing among women who smoke or who have existing coronary atherosclerosi s. Compared with the lipid effects of estrogens alone, the lipid effec ts of combined therapy with progestins may increase atherosclerosis. T he effect of progestins on coagulation factors is largely unknown, and no epidemiologic study has assessed the risk of cardiovascular diseas e associated with the use of combined hormone therapy in postmenopausa l women. Cardiovascular risk or benefit associated with the use of pos tmenopausal hormones may involve several competing mechanisms, includi ng effects on prostaglandins and vascular tone as well as atherosclero sis and thrombosis.