Heart Disease: HRT and CVD
For many years it was thought that the use of HRT reduced the risk of heart disease and indeed, many women took HRT mainly for that reason.
However, results of some trials, including the Women’s Health Initiative (WHI) trial initially suggested that women who took HRT had an increased risk of heart disease. This finding led to great concern, confusion and loss of confidence in the use of HRT. Since first publication of these results in 2002, further analysis has reassuringly shown that it was only in women who were 20 or more years post-menopause who took HRT in the trial (women who would be very unlikely to take HRT out-with a trial, in the “real” world) who had a small increased risk. Women who were within 10 years of the menopause, had no increased risk and had a trend towards a reduced risk.
There have been many studies showing reasons why the use of estrogen, the main component of HRT, should be beneficial for heart health since it has been shown to reduce LDL cholesterol, increase HDL cholesterol, reduce the deposition of cholesterol in blood vessel walls, and favourably influence the “pear” to “apple” weight distribution.
However, we do not yet have enough evidence to be able to again use HRT in the belief that it protects against heart disease, though we can reassure women that when used for symptom control in the early menopausal years, it will not harm heart health and may yet prove to be beneficial. Results from further trials, particularly looking at the best type and route of HRT, are awaited.