Atherosclerosis and hormone replacement therapy. Benefit or risk

It was believed that hormone replacement therapy (HRT) is able to reduce cardiovascular diseases, particularly coronary heart disease (CHID), up to 50%, and that also prevention after myocardial infarction should be possible with HRT. Since HERS, this benefit has been questioned and risks have been strongly discussed. Critical analysis, especially of recent trials concerning CHID, and also consideration of the metabolic and vascular hormone effects point to the fact that benefits and risks have to be balanced in a very differentiated manner. Within the first months after myocardial infarction HRT can cause high risks. As recently shown in the prematurely stopped WHI trial, also in apparently "healthy" women with treatment initiation at higher age, especially with cardiovascular risk factors, increased risk seems to be more likely rather than cardiovascular prevention due to frequently preexisting arteriosclerotic lesions. Since the risk of myocardial infarction is increased directly after menopause, cardiovascular benefit most likely can be expected by early replacement of the missing estradiol using physiological dosages, Until further interventional studies are available, HRT should not be initiated for the sole purpose of cardiovascular prevention. In patients with increased risk estrogens and, particularly progestins should be kept at lowest dosages.