Yorkshire Menopause Group

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HRT and arterial disease: what we know and what we need to know
13 September 2001

Abstract:
Until the publication of the Heart and Estrogen/Progestogen Replacement Study (HERS) in 1998, many in the medical and lay community were reassured as to the potential cardio-protective effect of Hormone Replacement Therapy (HRT). Evidence for this assumption was based upon the beneficial effects of oestrogen on several surrogate cardiovascular risk markers together with a wealth of observational data demonstrating a reduction in Coronary Heart Disease (CHD) in users of HRT. However showed no reduction in CHD related events in users of conjugated equine oestrogen (CEE) combined with medroxyprogesterone acetate (MPA) compared with users of placebo.

Of greater concern, there was an observed increased incidence of non-fatal myocardial infarction in the first year of therapy in those taking HRT. This study has led to the re-evaluation of the role of HRT for women with established or at high risk of CHD.

The aim of this talk is to explain the pattern of results seen in HERS by elaborating novel information on the effects of differing HRTs on pathways linked to atherogenesis, for example inflammation. In addition, based on available data, suggestions as to which types of HRT may be more appropriate for those at high risk of CHD will be made. Finally, areas where further studies are urgently required will be outlined.

? Dr Naveed Sattar
Senior Lecturer in endocrinology and metabolism and Honorary consultant, University Department of Pathological Biochemistry, Glasgow Royal Infirmary University NHS Trust.

e-mail: nsattar@clinmed.gla.ac.uk

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