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Review
Postmenopausal hormone therapy for cardiovascular health: the evolving data
  1. Felice L Gersh1,
  2. James H O’Keefe2,
  3. Carl J Lavie3
  1. 1 Internal Medicine, Fellowship in Integrative Medicine, University of Arizona College of Medicine, Irvine, California, USA
  2. 2 University of Missouri-Kansas City, Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
  3. 3 Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, Louisiana, USA
  1. Correspondence to Dr Carl J Lavie, Cardiology, John Ochsner Heart and Vascular Institute, New Orleans, LA 70121, USA; clavie{at}ochsner.org

Abstract

Postmenopausal (PM) hormone therapy (HT) was extremely popular for years as a treatment for many conditions, including cardiovascular (CV) disease (CVD) prevention. The adverse results from the Women’s Health Initiative (WHI) ended the widespread prescriptive use of HT for nearly 20 years. The WHI findings have been broadly and unfairly applied to all hormone formulations, including modern treatments using human-identical hormones. Although CV health is indisputably linked to oestrogen status, HT involving any combination of hormones currently is not recommended for primary or secondary prevention of CVD. In the wake of more positive results from recent studies and re-evaluation of the WHI, HT has re-emerged as an issue for specialists in CVD to discuss with their patients. Rigorous scientific analysis is needed to explain the paradox of cardioprotection conferred by endogenous ovarian hormones with apparent cardiotoxicity inflicted by HT. This review will cover the origins of HT, hormone terminology and function, and key studies that contribute to our current understanding. Based on evolving evidence, if HT is to be used, we propose it be initiated immediately after cessation of ovarian hormone production and dosed as transdermal oestradiol combined with cyclic dosing of human-identical progesterone (P4).

  • pharmacology
  • cardiac risk factors and prevention
  • heart disease
  • pharmacology
  • clinical

https://doi.org/10.1136/heartjnl-2019-316323

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    • Twitter @drfelicegersh

    • Contributors All authors contributed to this manuscript in all ways.The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license (or non-exclusive for government employees on a worldwide basis to the BMJ Publishing Group Ltd (BMJPGL) and its licensees to permit this article (if accepted) to be published in HEART editions and any other BMJPGL products to exploit all subsidiary rights.

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    • Competing interests None declared.

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