Heart disease, postmenopause, and hormone replacement therapy (HRT)

Heart disease is the number one killer of women.1 Postmenopausal women have a higher risk of developing heart disease than younger women. The use of hormone replacement therapy (HRT) does not prevent heart disease. In fact, HRT increases heart-related risks.

  • HRT slightly increases stroke risk in all healthy postmenopausal women, regardless of risk factors.2, 3 The increase in strokes first becomes apparent during the second year of HRT use.4
  • In women who are 10 or more years past menopause, using HRT slightly raises the risk of heart disease. This means that for a small number of these women, taking HRT causes heart disease. Early signs of heart disease can first become apparent during the first year of hormone use.5, 6, 7
  • The Heart and Estrogen/Progestin Replacement Study (HERS) has shown an increased number of heart attacks in women with preexisting heart disease who were started on HRT.8

If you are considering taking HRT, determine whether HRT heart risks outweigh the possible benefits for you. Review your personal and family history of high blood pressure, heart attack, stroke, smoking, diabetes, and atherosclerosis with your health professional.

If you have risk factors for heart disease, you already have heart disease, or you have had a stroke, take steps to reduce your risk factors by quitting smoking if you're a smoker, exercising regularly, controlling your blood pressure, and keeping your cholesterol low with a healthy diet and a cholesterol-lowering (statin) medication, if needed.

Talk to your doctor to find out whether a daily low-dose aspirin is right for you.

For more information about heart disease, risk factors, prevention, and treatment, see the topic Coronary Artery Disease.

Citations

  1. American Heart Association (2007). Women, Heart Disease, and Stroke Survey Highlights. Available online: http://www.americanheart.org/presenter.jhtml?identifier=10382.
  2. Rossouw JE, et al. (2002). Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. JAMA, 288(3): 321–333.
  3. Manson JE, et al. (2003). Estrogen plus progestin and the risk of coronary heart disease. New England Journal of Medicine, 349(6): 523–534.
  4. Wassertheir-Smoller S (2003). Effect of estrogen plus progestin on stroke in postmenopausal women. The Women's Health Initiative: A randomized trial. JAMA, 289(20): 2673–2684.
  5. Grodstein F, et al. (2006). Hormone therapy and coronary heart disease: The role of time since menopause and age at hormone initiation. Journal of Women's Health, 15(1): 35–44.
  6. Prentice RL, et al. (2006). Combined analysis of Women's Health Initiative observational and clinical trial data on postmenopausal hormone treatment and cardiovascular disease. American Journal of Epidemiology, 163(7): 589–599.
  7. Rossouw JE, et al. (2007). Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA, 297(13): 1465–1477.
  8. Hulley S, et al. (1998). Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA, 280(7): 605–613.

Last Updated: May 16, 2008

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