Appropriate Prescribing of Hormone Replacement Therapy in Women with Cardiovascular Disease (CAD) or at Risk for CAD

George Shapiro, M.D.

Adjunct Assistant Professor Clinical Medicine, New York Medical College, Valhalla, NY President, Cenegenics, New York City Member, AMMG Conference Planning Committee

Hormone Replacement therapy (HRT) in women has had its ups and downs over the past 35 years. Observational studies in the 1980s and 1990s have shown a reduction in cardiovascular disease (CAD) in postmenopausal women using HRT. The Women’s Health Initiative (WHI) study in 1991 showed an increased risk of CAD while the estrogen only arm of that trial in 2002 showed no effect on CAD. The North American Menopause Society and the international menopause societies all do not recommend use of HRT to decrease CAD. The Kronos Early Estrogen Prevention Study (KEEPS) trial in 2012 from Harvard Medical School showed favorable effects of HRT in newly menopausal women. Other studies performed at the Mayo Clinic showed that HRT might have a role in preventing CAD. The current lecture will review some of the more recent published studies from peer reviewed medical journals. Topics will focus on how HRT is associated with a marked improvement in survival in postmenopausal women with advanced HF; how HRT significantly increases apolipoprotein A-I levels and decreases Lp(a) and the effects on serum markers of inflammation in women with CAD; and how HRT protects against smoking-induced changes in vascular structure and function. Results of a recent study presented at this year’s American College of Cardiology’s 66th Annual Scientific Sessions that showed lower atherosclerosis and very clear survival benefits in women using hormone replacement therapy will also be discussed. New Biomarkers to evaluate vulnerable plaques in women to see if they are candidates for HRT will also be addressed.