European Heart Journal Advance Access published online on July 20, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm296
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Management of cardiovascular risk in the peri-menopausal woman: a consensus statement of European cardiologists and gynaecologists
1 NHLI, Imperial College London, Royal Brompton Hospital, Dovehouse Street, London SW3 6LY, UK
2 Centre for Clinical and Basic Science, San Raffaele-Roma, Rome, Italy
3 Department of Obstetrics and Gynaecology, St John's Hospital, Limerick, Ireland
4 Department of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
5 Department of Endocrinology, Reproductive Medicine and Osteoporosis, Philipps University of Marburg, Marburg, Germany
6 Department of Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
7 Instituto Palacios of Woman's Health, Madrid, Spain
8 Clinical Research Center, Department of Medicine, University of Miami School of Medicine, Miami, FL, USA
9 Department of Pharmacology, Saint-Antoine, Pierre et Marie Curie University, Paris, France
10 Department of Cardiology, IRCCS, Istituto Auxologico Italiano, Milan, Italy
Received 10 October 2006; revised 30 May 2007; accepted 14 June 2007.
* Corresponding author. Tel: +44 20 7351 8112; fax: +44 20 7823 3392. E-mail address: peter.collins{at}imperial.ac.uk
Cardiovascular risk is poorly managed in women, especially during the menopausal transition when susceptibility to cardiovascular events increases. Clear gender differences exist in the epidemiology, symptoms, diagnosis, progression, prognosis, and management of cardiovascular risk. Key risk factors that need to be controlled in the peri-menopausal woman are hypertension, dyslipidaemia, obesity, and other components of the metabolic syndrome, with the avoidance and careful control of diabetes. Hypertension is a particularly powerful risk factor and lowering of blood pressure is pivotal. Hormone replacement therapy is acknowledged as the gold standard for the alleviation of the distressing vasomotor symptoms of the menopause, but the findings of the Women's Health Initiative (WHI) study generated concern for the detrimental effect on cardiovascular events. Thus, hormone replacement therapy cannot be recommended for the prevention of cardiovascular disease. Whether the findings of WHI in older post-menopausal women can be applied to younger peri-menopausal women is unknown. It is increasingly recognized that hormone therapy is inappropriate for older post-menopausal women no longer displaying menopausal symptoms. Both gynaecologists and cardiovascular physicians have an important role to play in identifying peri-menopausal women at risk of cardiovascular morbidity and mortality and should work as a team to identify and manage risk factors such as hypertension.
Key Words: Cardiology • Cardiovascular prevention • Cardiovascular risk • Gynaecology • Hormones • Hypertension • Menopause • Metabolic syndrome
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