HORMONE REPLACEMENT THERAPY IN POSTMENOPAUSAL WOMEN WITH SPECIFIC RISK-FACTORS FOR CORONARY-ARTERY DISEASE

Hormone replacement therapy (HRT) in postmenopausal women is associate d with a reduction in the risk of developing coronary artery disease ( CAD) of about 50%. Women with an elevated risk for CAD appear to benef it most by HRT. The HRT-associated cardiovascular protection may be re lated to favourable changes in several important cardiovascular risk e stimators, such as circulating blood concentrations of cholesterol, li poprotein(a) (Lp(a)) and homocysteine. This paper reviews the literatu re presently available on the effects of HRT on cholesterol, Lp(a) and homocysteine concentrations, and special attention will be given to t he effects on their elevated concentrations. The effect of HRT in wome n with hypertension is reviewed as well. From this overview it can be concluded that risk factors such as cholesterol, Lp(a), and homocystei ne can be favourably modulated by HRT, and especially, that the strong est reductions can be achieved in those women with the highest concent rations. Although clinical trials still need to demonstrate the impact of lowering concentrations of Lp(a) and homocysteine, HRT appears to be a promising risk reduction strategy in this respect. (C) 1998 Elsev ier Science Ireland Ltd. All rights reserved.