Hormones, women, and cardiovascular disease: Primary vs. secondary prevention after menopause

Hormone replacement therapy (HRT) may provide greater benefits or risks to women after menopause depending on the patient's clinical history. This rev iew focuses on the effects of HRT on primary vs. secondary prevention of ca rdiovascular disease. For women without known cardiovascular disease, HRT m ay reduce risk through improvement in lipids, cardiac contractility, and bo dy composition. The improvement in vasodilatation with estrogen may be dilu ted by the addition of a progestin, The effects of HRT on coagulation and v ascular inflammation are more difficult to interpret. For women with known disease, HRT may reduce subclinical atherosclerosis and increase long-term survival after coronary artery bypass grafting, However, it may not prevent subsequent cardiac events and may increase the short-term risk of thrombos is for these patients. Understanding the risks and benefits of HRT relative to cardiovascular history should allow physicians to provide useful inform ation to patients.