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Hormone Replacement Therapy to Protect your Heart?
Introduction
Coronary Heart Disease is a major health problem in the world, especially in developed nations, and becoming the leading cause of death in the world. Recently medical knowledge and technologies include diagnostic and therapy give about 40% reduction in mortality rate compare to previous two decade.
The Declining of mortality rate is related to optimal medical therapy and revascularization therapy (surgical or PCI).
Clinical manifestation of coronary heart disease is varied from asymptomatic, acute onset chest pain or angina, heart attack, heart failure, and sudden death.
Coronary heart disease is understood as a process of vessel degeneration, causing by cholesterol deposition in vessel wall. Progressive deposition of cholesterol in vessel wall leads to narrow vessel lumen, thus impair blood circulation to distal organ. Besides narrowing vessel lumen, cholesterol plaques in vessel isn't stabil product, and easy to tear, when its tears, it lead to clot formation thus will cause further obstruction of blood flow.
Women and Heart Problem
It has been well known by epidemiological study that women during their reproductive age, is associated with lesser risk of cardiovascular disease compare to men.
Thus raising consent about potential hormonal role in cardiovascular disease. The protective role of estrogen in the prevention of atherosclerotic disease, is due to effects on lipids, and its antioxidant, antiinflammatory, and vasomotor properties, the biological plausibility of estrogen supported its beneficial effect.
Women will experience a period of menopause, when there is a drop in hormone production. Thus leads to low estrogen level in serum. And based on observational study, women after menopause increases the risk of cardiovascular disease. Does hormonal replacement therapy give health benefits exceed the health hazards?
HRT for Heart Protection?
Large observational studies of women have suggested an inverse relationship between estrogen and coronary heart disease (CHD). But those results has been shown contradictory recently, that the role of estrogen in the treatment and prevention of CHD was really questioned.
Several trials were assigned to measure the benefits of hormonal replacement therapy in menopausal women. In the HERS trial, women did have potentially beneficial effects on their lipids, with lower low-density lipoprotein cholesterol levels and higher high-density lipoprotein cholesterol levels, but there was no difference in the primary outcome, nonfatal myocardial infarction or CHD death. However there was, a 50% increase in the primary outcome in the first year of the trial.
This outcomes, leads to scientific investigation about the role of estrogen in the atherosclerotic process and importantly, during the acute event. The prothrombotic effect of estrogen as well as the role of estrogen in the inflammatory process were implicated as potential mechanisms for the increased events within the first year.
The Women's Health Initiative (WHI) trial was designed to evaluate strategies for the prevention and control of several disease states affecting postmenopausal women, including Coronary heart disease by using continuous combined hormone replacement therapy (HRT). WHI trial results showed that only small fraction of these women had established CHD. But, based on the safety monitoring board, the trial had been stopped due to adverse increase in breast cancer and endometrial cancer. Analysis of outcomes in estrogen-only arm and showed no benefit of estrogen therapy in the prevention of CHD.
Take home message
Based on these results, guidelines for health care professionals advised against the use of estrogen for the purpose of cardiovascular disease prevention. The risk-benefit ratio of estrogen therapy would have to be weighed against serious menopausal symptoms. Recent trials shows no difference in cardiovascular outcomes, but a continued increase in the risk of fatal and nonfatal malignancies in those randomized to receive estrogen/progestin therapy. Overall, the risks of therapy with combination therapy outweigh the benefits of therapy for chronic disease prevention. With these new results, practitioners must carefully weigh the risks and benefits of combined estrogen/progestin therapy in postmenopausal women.
Citation: JAMA 2008
Coronary Heart Disease is a major health problem in the world, especially in developed nations, and becoming the leading cause of death in the world. Recently medical knowledge and technologies include diagnostic and therapy give about 40% reduction in mortality rate compare to previous two decade.
The Declining of mortality rate is related to optimal medical therapy and revascularization therapy (surgical or PCI).
Clinical manifestation of coronary heart disease is varied from asymptomatic, acute onset chest pain or angina, heart attack, heart failure, and sudden death.
adopted from http://elev8.com/health
Coronary heart disease is understood as a process of vessel degeneration, causing by cholesterol deposition in vessel wall. Progressive deposition of cholesterol in vessel wall leads to narrow vessel lumen, thus impair blood circulation to distal organ. Besides narrowing vessel lumen, cholesterol plaques in vessel isn't stabil product, and easy to tear, when its tears, it lead to clot formation thus will cause further obstruction of blood flow.
Women and Heart Problem
It has been well known by epidemiological study that women during their reproductive age, is associated with lesser risk of cardiovascular disease compare to men.
Thus raising consent about potential hormonal role in cardiovascular disease. The protective role of estrogen in the prevention of atherosclerotic disease, is due to effects on lipids, and its antioxidant, antiinflammatory, and vasomotor properties, the biological plausibility of estrogen supported its beneficial effect.
adopted from http://www.foxnews.com
Women will experience a period of menopause, when there is a drop in hormone production. Thus leads to low estrogen level in serum. And based on observational study, women after menopause increases the risk of cardiovascular disease. Does hormonal replacement therapy give health benefits exceed the health hazards?
HRT for Heart Protection?
Large observational studies of women have suggested an inverse relationship between estrogen and coronary heart disease (CHD). But those results has been shown contradictory recently, that the role of estrogen in the treatment and prevention of CHD was really questioned.
Several trials were assigned to measure the benefits of hormonal replacement therapy in menopausal women. In the HERS trial, women did have potentially beneficial effects on their lipids, with lower low-density lipoprotein cholesterol levels and higher high-density lipoprotein cholesterol levels, but there was no difference in the primary outcome, nonfatal myocardial infarction or CHD death. However there was, a 50% increase in the primary outcome in the first year of the trial.
This outcomes, leads to scientific investigation about the role of estrogen in the atherosclerotic process and importantly, during the acute event. The prothrombotic effect of estrogen as well as the role of estrogen in the inflammatory process were implicated as potential mechanisms for the increased events within the first year.
The Women's Health Initiative (WHI) trial was designed to evaluate strategies for the prevention and control of several disease states affecting postmenopausal women, including Coronary heart disease by using continuous combined hormone replacement therapy (HRT). WHI trial results showed that only small fraction of these women had established CHD. But, based on the safety monitoring board, the trial had been stopped due to adverse increase in breast cancer and endometrial cancer. Analysis of outcomes in estrogen-only arm and showed no benefit of estrogen therapy in the prevention of CHD.
Take home message
Based on these results, guidelines for health care professionals advised against the use of estrogen for the purpose of cardiovascular disease prevention. The risk-benefit ratio of estrogen therapy would have to be weighed against serious menopausal symptoms. Recent trials shows no difference in cardiovascular outcomes, but a continued increase in the risk of fatal and nonfatal malignancies in those randomized to receive estrogen/progestin therapy. Overall, the risks of therapy with combination therapy outweigh the benefits of therapy for chronic disease prevention. With these new results, practitioners must carefully weigh the risks and benefits of combined estrogen/progestin therapy in postmenopausal women.
Citation: JAMA 2008
