The British Menopause Society Council is committed to provide up to date authoritative reviews to aid health professionals to inform and advise women about key issues in postreproductive health. Coronary heart disease is a leading cause of death in women. Observational studies have consistently shown estrogen to help prevent coronary heart disease in postmenopausal women. The large randomized controlled Women’s Health Initiative trial initially did not confirm these observational findings. However, further analyses of the Women’s Health Initiative study as well as meta-analyses of randomized clinical trials of hormone replacement therapy and of the observational Nurses’ Health Study have now found that the timing of onset of hormone replacement therapy use is important and that estrogen may have an important protective role in coronary heart disease, particularly in women initiating treatment below age 60 years. This consensus statement will examine the evidence regarding hormone replacement therapy and non-estrogen therapies (lipid-lowering agents, aspirin, antihypertensives, anti-diabetic medications, selective estrogen receptor modulators) as well as diet, lifestyle and smoking cessation in the primary prevention of coronary heart disease in women.
The Timing Hypothesis and Hormone Replacement Therapy: A Paradigm Shift in the Primary Prevention of Coronary Heart Disease in Women. Part 1: Comparison of Therapeutic Efficacy
