Hormone replacement treatment and cardiovascular impact

Abstract

Cardiovascular disease (CVD) is the most prevalent cause of death among women. Differences in presentation, results, and pathological mechanisms between genders result in CVD being more serious for women than for men¹. There is a delay in the onset of CVD in women compared to men, due to the cardioprotective effects of endogenous estrogen. Estrogens have protective effect on: vascular endothelium, lipid profile, glucose metabolism; and an anti-inflammatory effect².

Menopause is a physiologic event defined by the loss of ovarian follicular function and the final menstruation period. The average age of menopause has been remarkably stable over time and varies little between ethnic groups. Menopause is considered natural when it occurs spontaneously after the age of 45 years. Menopause is described as early when it occurs in women aged 40 to 45 years. It must be differentiated from premature ovarian failure (POF), which occurs before the age of 40³. Observational data have indicated that untreated POF regardless of cause is associated with an increased risk of CVD, mortality, osteoporosis, cognitive impairment and dementia².

Menopausal replacement therapy (MRT) is used in women younger than 60 years and/or within 10 years of the onset of menopause and is approved for four indications: moderate to severe vasomotor symptoms (VMS); treatment of osteoporosis in early postmenopausal women; POF of any etiology and treatment of genitourinary syndrome (GUS) for which local treatment is suggested³. MRT is not currently recommended by any medical society for primary or secondary prevention of CVD⁴.

Transdisciplinary care can enable a more streamlined risk assessment, initiation of appropriate therapies for menopausal symptoms, and longitudinal reduction of cardiovascular risk through a holistic patient-centered approach. We must remember that prior to the onset of MRT, it is essential to evaluate cardiovascular disease risk factors (CVRF). The age of the patient, the time of menopause and the presence or absence of CVRF will determine the use of it^1,2.