HORMONE REPLACEMENT THERAPY AND CARDIOPROTECTION - BASIC CONCEPTS ANDCLINICAL CONSIDERATIONS

A large body of epidemiological evidence shows that estrogen use after the menopause reduces the incidence of cardiovascular disease up to 5 0%. The use of progestin as co-medication in HRT appears not to attenu ate the cardioprotective effects of estrogen. Menopause-related change s in metabolic cardiovascular risk factors are identifiable, as are HR T-related changes in these factors. Estrogens may act in a gender-spec ific way on vascular endothelial cells and other components of the ves sel wall enhancing the synthesis and release of NO and other vasodilat ors and by inhibiting the synthesis and release of vasoconstricting ag ents, thus favoring vasodilation. Angiographic studies demonstrated in postmenopausal women with ischemic heart disease a reduction in coron ary stenosis by estrogen monotherapy. Several studies, including the P EPI-trial, failed to demonstrate any major effect of HRT on blood pres sure. The information on HRT and cardioprotection which is available s o far is very promising and merits recommending HRT not only in health y women but also in women with cardiovascular disease as well as in wo men with increased risk for this disease. (C) 1997 Elsevier Science Ir eland Ltd.