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Title Cardiovascular disease remains the single largest cause of death in women
Date 9 March 2011
Full Story Cardiovascular disease remains the single largest cause of death in women. Much interest has been shown in the effects of Hormone Replacement Therapy on the risk of cardiovascular disease, with observational studies showing a significant reduction in risk, and randomised controlled trials (RCTs) showing an increase.

The Timing Hypothesis suggests that the time since menopause that HRT is commenced influences the effect of hormones on the cardiovascular system and continues to be questioned as an explanation for the discrepant outcomes. A group has recently reported on the evidence regarding the basis of the hypothesis and its suitability to explain differences in outcomes between trials of hormone therapy commenced early following the menopause, as in observational studies, and therapy which is delayed as in RCTs.

From a literature review, reports of laboratory, animal and human studies were shown to support the different effect of HRT on normal versus diseased vessels, with a beneficial effect when HRT is commenced early with healthy blood vessels, compared to a negative effect when therapy is delayed with vascular disease. Age and time since menopause have been related to the extent of vascular disease in women. The group concluded that there is ample evidence of the validity of the Timing Hypothesis as an explanation of the different outcomes of observational studies and RCTs and recommend that research on cardiovascular disease prevention by early HRT should be the highest national priority.

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