(Circulation. 1996;93:1928-1937.)
© 1996 American Heart Association, Inc.
Articles |
Cardiovascular Effects of Estrogen and Lipid-Lowering Therapies in Postmenopausal Women
From the Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md.
Correspondence to Richard O. Cannon III, MD, National Institutes of Health, Bldg 10, Room 7B15, 10 Center Dr MSC 1650, Bethesda, MD 20892-1650.
Key Words: atherosclerosis • lipoproteins • hormones • women • drugs
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Introduction |
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Despite impressions to the contrary, cardiovascular disease is the leading cause of death among women in the United States, as it is among men.1 However, myocardial infarction and stroke are uncommon in women until their sixth decade and beyond. Clinicians have long suspected that the delay of a decade or more in cardiovascular disease expression in women relative to men is due to the protective effects of estrogen during a woman's reproductive years. Women in the Nurses' Health Study who underwent surgical menopause by bilateral oophorectomy without estrogen replacement had more than twice the risk of subsequent clinically apparent coronary heart disease as postoperative women who received estrogen therapy.2 In recent years, reports from population-based observational studies of favorable effects of estrogen therapy on cardiovascular morbidity and mortality3 4 5 have led to enthusiasm for widespread use of estrogen by postmenopausal women for prevention of cardiovascular disease events. The guidelines for estrogen therapy issued by the American College of Physicians include the statement, "Women who have coronary heart disease or who are at increased risk for coronary heart disease are likely to benefit from hormone therapy."6
However, any potential cardiovascular benefit of
estrogen, in addition to other benefits, such as preservation of bone
mass, must be weighed against uterine cancer risks and possible breast
cancer risks with prolonged use.7 8 Indeed, despite
widespread publicity in recent years about heart disease in
postmenopausal women and the apparent cardiovascular
virtues of estrogen, many women consider their risk of heart disease
lower than their risk of
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