C disease (CVD) is the leading cause of death among US women. Despite this fact, CVD is perceived mainly as a disease of middle-aged men. Female patients often seriously underestimate the risk of CVD faced by themselves and other women, focusing instead on other causes of morbidity and mortality, such as cancer.1 At the same time, physicians may underdiagnose heart disease in women because of a lack of awareness. Women often present differently from men, with atypical chest pain and less specificity for exercise stress testing. Perhaps, because of missed diagnoses, women tend to have more advanced disease at the time of diagnosis and less favorable outcomes after first or subsequent myocardial infarctions.2 The risk of CVD in women increases substantially after menopause. This finding is believed to be caused in part by the loss of estrogen, which has multiple protective effects on the vascular system (reviewed by Mendelsohn and Karas).3 Numerous observational studies have shown a cardioprotective benefit when estrogen replacement therapy/hormone replacement therapy (ERT/HRT) is given to healthy women after menopause. However, recent randomized trials (Heart and Estrogen/ progestin Replacement Study [HERS], Estrogen Replacement and Atherosclerosis [ERA] trial) have suggested that in women with well established CVD, ERT and HRT do not have a protective effect, and they may even lead to an increased risk of coronary events in their first year of use.4,5 It is important to emphasize that these trials were for secondary CVD prevention in older postmenopausal women with established CVD only, and that they included only a single combination HRT regimen. The results obtained in these trials are therefore not relevant to the potential effect of primary prevention of CVD in healthy women or to use of the newer HRT formulations that are now available. Unfortunately, these studies have been extensively overinterpreted as well as misinterpreted.6 Because of the misinterpretation of these studies, there is considerable confusion in the medical community about the use of HRT and its potential effects on CVD risk. Table 1 lists some of the most common misconceptions. These issues were addressed at a roundtable discussion held in Los Angeles on June 21, 2001, attended by a multidisciplinary panel of physicians with expertise in the fields of cardiology, obstetrics and gynecology, and epidemiology. The objecFrom the Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA; and Tufts University School of Medicine, Molecular Cardiology Research Institute, Tufts–New England Medical Center, Boston, Massachusetts, USA. Address for reprints: Daniel R. Mishell, Jr., MD, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Mail Code 999, Building WCH L-1009, 1240 North Mission Road, Los Angeles, California 90033.
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