European Heart Journal Advance Access originally published online on April 28, 2005
European Heart Journal 2005 26(14):1358-1361; doi:10.1093/eurheartj/ehi297
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Menopausal complaints, oestrogens, and heart disease risk: an explanation for discrepant findings on the benefits of post-menopausal hormone therapy
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Room STR 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
Received 1 December 2004; revised 31 January 2005; accepted 24 March 2005; online publish-ahead-of-print 28 April 2005.
* Corresponding author. Tel: +31 30 250 9360; fax: +31 30 250 5485. E-mail address: y.t.vanderschouw{at}umcutrecht.nl
See page 1345 for the editorial comment on this article (doi:10.1093/eurheartj/ehi354)
Abstract
There is a large discrepancy between the findings of observational and experimental studies on the effects of post-menopausal hormone therapy (HT) and coronary heart disease risk. Observational studies, mainly comprising peri-menopausal women, report risk reductions up to 30–50%, whereas the experimental studies, comprising elderly women, do not show coronary protection. Suggested explanations are methodological differences, such as confounding or healthy user bias, incomplete capture of early events, the stage of atherosclerosis at the start of HT, formulation or dose of HT, or early susceptibility to thrombotic events. We propose that the presence of climacteric complaints determines the susceptibility to hormone replacement therapy. Climacteric complaints are the main indication for HT in the population, whereas in the clinical trials women with climacteric complaints were either explicitly excluded or comprised only a minority of the total randomized population. There is some, albeit circumstantial evidence to support this hypothesis. Women with climacteric complaints of sweating not only appear to have lower levels of serum oestradiol, but also lose more bone than women without climacteric complaints. Consequently, sweating episodes may indicate potential benefits from HT. It has also been reported that hot flushes during menopause correlate with a higher level of oxidative stress and an increased cardiovascular reactivity to stressful situations. We suggest epidemiological approaches to test our hypothesis.
Key Words: Hot flushes • Post–menopausal hormone therapy • Post–menopausal women • Cardiovascular diseases • Menopausal complaints
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