Heart disease, postmenopause, and hormone replacement therapy (HRT)

Heart disease is the number one killer of women.¹ Postmenopausal women have a higher risk of developing heart disease than younger women. The use of hormone replacement therapy (HRT) does not prevent heart disease. In fact, HRT increases heart-related risks.

• HRT slightly increases stroke risk in all healthy postmenopausal women, regardless of risk factors.^{2, 3} The increase in strokes first becomes apparent during the second year of HRT use.⁴
• In women who are 10 or more years past menopause, using HRT slightly raises the risk of heart disease. This means that for a small number of these women, taking HRT causes heart disease. Early signs of heart disease can first become apparent during the first year of hormone use.^{5, 6, 7}
• The Heart and Estrogen/Progestin Replacement Study (HERS) has shown an increased number of heart attacks in women with preexisting heart disease who were started on HRT.⁸

If you are considering taking HRT, determine whether HRT heart risks outweigh the possible benefits for you. Review your personal and family history of high blood pressure, heart attack, stroke, smoking, diabetes, and atherosclerosis with your health professional.

If you have risk factors for heart disease or already have heart disease, take steps to reduce your risk factors by quitting smoking if you're a smoker, exercising regularly, controlling your blood pressure, and keeping your cholesterol low with a healthy diet and a cholesterol-lowering (statin) medication, if needed.

If you are at moderate to high risk or have heart disease, talk to your health professional about whether daily low-dose aspirin and/or beta blockers may help you. Also, for perimenopausal symptoms, choose from nonhormonal treatment options.

For more information about heart disease, risk factors, prevention, and treatment, see the topic Coronary Artery Disease.

Author:	Robin Parks, MS	Last Updated: May 19, 2008
Medical Review:	Anne C. Poinier, MD - Internal Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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