Menopausal Hormone Treatment and the Progression of Vascular Disease

Abstract

Observational studies and laboratory research support cardioprotective effects of menopausal hormone treatment (MHT). However, cardioprotective effects of MHT were not confirmed by randomized clinical studies that were made up of subjects who were well-beyond the time of menopausal symptoms and were of advanced chronological age when they began hormone treatment (HT). The differences in study outcomes most likely reflect age-related differences in cardiovascular risk factors such as hypertension and metabolic syndromes. As well, data from the randomized clinical trial (RCT)s confirmed the presence of actual cardiovascular disease (CVD) in many of the RCT subjects prior to beginning HT. Therefore, beginning MHT early seems crucial since older women are at greater risk for the presence of risk factors and sub-clinical CVD. Older women also are possible targets of hormonally related thrombosis because of their underlying vascular disease. The need for early prophylaxis is convenient since most women seek treatment for symptoms within the first few years of menopause. This review addresses issues regarding optimization of the initiation of MHT for cardioprotection.