The therapeutic implications of oestrogens in cardiovascular diseases

Abstract

Cardiovascular disease and its consequences constitute a major public health problem. The main cardiovascular disease is coronary heart disease (CHD), which is caused by atherosclerosis. At younger ages women suffer less CHD than men, but later in life this advantage disappears. There are many risk factors for the development of atherosclerosis, and in women the menopause appears to be one of them. The menopause results in a deficiency of oestrogens and progesterone. There are a number of observational studies that suggest that hormone replacement therapy (HRT) has a beneficial effect on the postmenopausal cardiovascular system. There are also ample experimental data and results from interventional studies to support this observation. Unfortunately, long-term compliance with HRT is poor. This may be due to: insufficient motivation unpleasant side-effects, especially the return of monthly bleeds fear of long-term consequences such as breast cancer, endometrial cancer and venous thromboembolism failure of the medical profession to disseminate more widely the benefits of long-term HRT, other than the treatment of vasomotor symptoms and prevention and treatment of osteoporosis. The potential HRT market is huge, but, in order to increase the uptake and compliance of HRT, improvements in the above points are needed. Women's needs and concerns must be adequately addressed, and the future may lie with the development of new HRT regimens and new HRT drugs, which minimise the unpleasant side-effects, dispel the fear of long-term adverse consequences, target a particular organ/system, and allow prescription for a single indication, e.g., vasomotor symptoms, low bone density, high risk of CHD, or any combination of these.