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Prevention of Cardiovascular Disease in Women: Evidence for the Use of Hormone Replacement Therapy

Introduction Coronary artery disease (CAD) is a major cause of morbidity and mortality in women. The burden of death and disability from CAD increases with age and on average women present with symptomatic CAD about 10 years later than men. One in every two women who reaches the age of 50 will eventually die of heart disease or stroke. I Since 1984 there has been a declining death rate from cardiovascular disease in men, but mortality from cardiovascular disease in women has increased. Many studies, including the Framingham Heart Study, have reported that the incidence of cardiovascular disease in postmenopausal women is higher than that of premenopausal women of the same age range.f The reason for this apparent protection in women is thought to be circulating sex hormones, in particular oestrogens, which decrease rapidly after the menopause.J The loss of endogenous oestradiol production by the ovaries at menopause coupled with the increased risk of CAD associated with premature menopause suggests that oestrogen replacement therapy may reduce the risk of CAD in post-menopausal women.f