Hormone Replacement Therapy and Cardiovascular Disease: A Statement for Healthcare Professionals From the American Heart Association

Abstract

To the Editor: I was personally disturbed by the American Heart Association (AHA) statement on hormone therapy and cardiovascular disease that recently was published in Circulation .1 Two different medical journals, Climacteric 2 and Maturitas ,3 recently published a position paper from the Workshop on Controversial Issues in Climacteric Medicine: Hormone Replacement Therapy (HRT) and Cardiovascular Diseases, which was organized in October 2000 by the International Menopause Society (IMS). All persons interested in the health care of postmenopausal women should read it. Menopause experts, including internists and cardiologists, see the cardiovascular issue from a perspective different from that of American cardiologists, although they are interpreting the same database and research articles and, ultimately, are reaching similar conclusions. The authors of the AHA statement report that the biological basis of estrogen benefits the cardiovascular apparatus and mention epidemiological data showing a 35% reduction of cardiovascular events in normal women using hormones after menopause. However, their conclusions and final messages are different, referring mainly to the secondary prevention trial named the Heart and Estrogen/Progestin Replacement Study (HERS). The term HRT , as it is used in the article, includes treatment with estrogen alone or in combination with different progestins and using different schedules of administration. At the end of the article, the authors say that their conclusions are based primarily on a fixed dose of oral conjugated …