Menopausal hormone therapy and cardiovascular protection: state of the data 2003

Despite biologically plausible mechanisms for cardiac protection from estrogen therapy and observational data suggesting that hormone therapy confers cardiovascular benefit, the outcomes of well-designed and conducted primary and secondary prevention randomized clinical trials have documented cardiovascular risk rather than benefit. Menopausal hormone therapy failed to prevent clinical cardiovascular events in healthy menopausal women and in those with established coronary heart disease. Rather, it increased the risk of coronary heart disease events, particularly myocardial infarction, stroke, and venous thromboembolism, as well as that of breast cancer. Recommendations from the US Preventive Services Task Force emphasize that, for most women, the harms of hormone use are likely to exceed the benefits for the prevention of chronic disease. Women should talk with their health care providers about such proved approaches to coronary risk reduction as smoking cessation, heart-healthy diet, physical activity, weight management, and pharmacologic control of hypertension and hypercholesterolemia.