Turk Kardiyol Dern Ars. 1998; 26(5): 299-303
Role of Postmenopausal Estrogen Therapy in the Prevention of Coronary Heart Disease
Postmenopausal women lose protection from coronary heart disease (CDH) and this is probably related to the loss of estrogen. Estrogen raises levels of HDL-cholesterol and lowers levels of LDLcholesterol, Lp (a), fibrinogen and plasminogen activator-inhibitor-L It also prevents the oxidation of LDL-cholesterol and improves carbohydrate metabolism and insulin sensitivity. Estrogen also has direct actions on the arterial wall. lt dilates coronary arteries, abolishes the vasocostrictor response to acetylcholine, decreases the proliferation and migration of smooth muscle cell, inhibits foam cell formation and decreases collagen and elastin production. But do these anti-atherogenic effects of estrogen transiate into elinical benefits? The evidence for a benefit of estrogen on CHD iiı women, comes from observational case-control, cohort, cross-sectional epidemiological studies. Randomised, placebo-controlled trials studying the role of estrogen in primary or secondary prevention of CHD are lacking. Also in women with a uterus, unopposed estrogen is associated with an increased risk of endometrial cancer, therefore in most women, progesterone must be added to estrogen. The effect of this combination on the prevention of CHD is not well documented. It is known that long-term use of estrogen increases the risk for breast cancer. Two ongoing trials to answer the question of HRT are: Women's Health Initiative (WHI) study, a randomized placebo-controlled primary prevention trial of combined estrogen and progesterone replacement therapy in healthy women and Heart and Estrogen/Progesterone Replacement Study (HERS), a secondary prevention trial in women with documented coronary artery disease. The results of these elinical trials must be awaited. At present, whether to use HRT or not must be made on an individual basis, weighing the risks and benefits.Keywords:
atherosclerosis, coronary heart disease, menopause, hormon replacement therapy.
How to cite this article
Güneş AKGÜN. Role of Postmenopausal Estrogen Therapy in the Prevention of Coronary Heart Disease. Turk Kardiyol Dern Ars. 1998; 26(5): 299-303