Effect of Hormone Replacement Therapy on theCardiovascular System

Overview

Objective:
Analysis of contemporary knowledge of influences of hormone replacement therapy oncardiovascular system.Design: Literary review.Setting: Department of Gynecology and Obstetrics, 1th Faculty of Medicine, Charles University,Prague.Method: Informations were collected from fulltexts which were chosen in database Medline andOvid.Conclusion: Hormone replacement therapy (HRT) has positive influence on some risk factors ofcardiovascular disease. Changes in the lipoprotein spectrum are well known.Oral estrogens cause a decrease of low density lipoprotein cholesterol (LDL-C) and, especially anincrease of high density lipoprotein cholesterol (HDL-C) levels, which both have potentially favourableeffects; they also cause a triglyceride level increase, which probably has no clinicalrelevance except in cases with basal hypertriglyceridemia. Transdermal estradiol causes generallya minor dicrease in LDL-C and minor increase HDL-C levels, with no increase or even decreasein triglyceride levels. The addition of androgenic progestins at conventionally used doses, whilenot interfering with LDL-C variations, causes a HDL-C decrease, which contrasts he effect of oralestrogens and completely reverses the effect of transdermal estradiol. On the contrary, the additionof a non-adrogenic progestin does not interfere with any of the estrogen induced lipid profilemodifications.Transdermal estradiol does not cause change of insulinoresistance. Estrogen substitution protectsgynoid distribution of body fat that is conected with lower risk of ischemic heart disease.Estrogens have posibility to dilate vessels. Decreasing of levels of cytoadhesive moleculs wasverificate during HRT so as lowering of homocysteine level to premenopausal levels.Newly uncovered changes like the significant increase of CRP conected with oral estrogenetherapy could explain increasing of cardiovascular risk on the beginning of HRT especially ingroup of women with history of ischemic heart disease.

Key words:
hormone replacement therapy, cardiovascular disease