Antiischemic effects of estrogens

Consideration of estrogen replacement therapy is well established in the tr eatment of postmenopausal syndrome and osteoporosis in menopause. Some obse rvational epidemiologic studies on this topic have suggested beneficial eff ects on cardiovascular disease. A prospective, controlled. randomized clini cal trial with respect to cardiovascular events and mortality in postmenopa usal hormone users, the HERS (Heart and Estrogen/Progestin Replacement) stu dy has recently been published. Antiischemic effects of estrogens are media ted by improve-ment of menopausal-associated endothelial dysfunction, calci um antagonism, and activation of endothelial synthesis of prostacyclin. Imp rovement in functional state and reduction of stress-induced myocardial isc hemia with hormone replacement therapy (HRT) have been demonstrated in seve ral clinical trials. Thus, because of available clinical data, introduction of HRT for cardiovas cular reasons in patients with coronary artery disease is still considered ambigous and cannot be generally recommended for secondary prevention in th is group of patients.