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The prevalence of the disease is slightly
higher in females (17%) than males (15%).
This number increases significantly with
age from 10% of those aged 35--44 years
to 70% of those aged 85 years or above.
CVD includes a range of conditions
including coronary heart disease,
heart failure, cardiomyopathy, congenital
heart disease, peripheral vascular disease
and stroke which can be life threatening.2
Most women who start menopause are
asymptomatic for cardiovascular diseases
and up to 95% of women develop
cardiovascular diseases after they
enter menopause. There is supporting
evidence that suggests the younger
women enter menopause, the higher
their risk of developing CVD. Moreover,
post-menopausal women have 2.6 times
the rate of cardiovascular events than
pre-menopausal events matched with
their same age. These findings suggest
that endogenous oestradiol can
reduce age related vascular events in
pre-menopausal women. Androgens on
the other hand induce vasoconstriction;
exacerbate atherosclerosis and plaque
formation, thus increasing the risk of
Hormone replacement therapy (HRT)
or hormone therapy refers to oestrogen
alone or a combination of oestrogen
and progesterone. Their clinical
effectiveness and duration of use
vary across the different formulations.
Long term treatment with hormone
therapy has some benefits in
preventing atherosclerosis. However,
some studies indicated that HRT is
involved in increased risk of cancer,
venous thromboembolism and stroke.
This evidence summary presents the
results of the above mentioned review.4
Characteristics of the studies
Quality of the research
Studies included in the report were
of moderate to high methodological
quality. Biases such as selection bias was
the major drawback.
The following databases were searched
Cochrane Central Register of Controlled
Trials (CENTRAL; Feb 2014) MEDLINE
(1946 to Feb 2014), and EMBASE (1974 to
Feb 2014) and LILACS (Feb 2014).
Trials registers and references checking
were also undertaken.
The review included a total of 19 studies,
involving 40,410 post-menopausal
women. The studies were all randomised
controlled trials of women administered
HRT with placebo or a no treatment
control for either a primary or secondary
prevention of CVD with a follow up of six
months or more.
The outcomes measured were; death
from all causes and cardiovascular
causes, stroke, venous thromboembolism
and pulmonary embolism.
HRT was found to have no protective
effects for all-cause mortality,
cardiovascular death, non-fatal
myocardial infarction, angina or
There was an increased risk of stroke in
the intervention group for combined
primary and secondary prevention
(RR 1.81, 95%CI 1.32 to 2.48).
There were increases in venous
thromboembolic events (RR 1.92, 95%
CI 1.36 to 2.69) and pulmonary emboli
(RR 1.81, 95% CI1.32 to 2.48).
Preventing CVD in
BY DR HANAN KHALIL
An estimated 3.4 million Australians or 17% the Australian population
have cardiovascular disease (CVD).
The purpose of this evidence summary is to provide
the best available evidence for the effectiveness
of hormone therapy for preventing cardiovascular
diseases in post-menopausal women. For the full
review, please refer to Boardman HMP, Hartley L,
Eisinga A, et al. Hormone therapy for preventing
cardiovascular disease in post-menopausal women.
Cochrane Database of Systematic Reviews 2015,
Issue 3. Art. No.: CD002229. DOI: 10.1002/14651858.
Dr Hanan Khalil is the Director of the Centre for
Chronic Disease Management, a collaborating centre
of the Joanna Briggs Institute, Faculty of Medicine,
Nursing and Health Sciences, Monash University, and
a reviewer for the consumer group of the Cochrane
Collaboration. Hanan is also the Editor in Chief of the
International Journal of Evidenced Based Health Care.
Women who started HRT therapy
less than 10 years after menopause
had lower mortality and coronary
heart diseases. However, they
were at increased risk of venous
Implications for research
Future studies should aim at addressing
the differences between the various
formulations of oestrogen and
progestogen with varying doses and
routes of administration.
The current evidence suggests that HRT
in post-menopausal women for either
primary or secondary prevention of
cardiovascular diseases events has no
benefit on preventing CVD and may
in fact increase the risk of stroke and
1. Boardman HMP, Hartley L, Eisinga A, et al. Hormone therapy
for preventing cardiovascular disease in post-menopausal
women. Cochrane Database of Systematic Reviews 2015,
Issue 3. Art. No.: CD002229. DOI: 10.1002/14651858.
2. Harrison, Christopher, et al. Prevalence of chronic
conditions in Australia. PloS one 8.7 (2013): e67494.
3. O'Neil, Adrienne, et al. The health-related quality of life
burden of co-morbid cardiovascular disease and major
depressive disorder in Australia: findings from a population-
based, cross-sectional study. Quality of life research
4. Schierbeck, Louise Lind, et al. Effect of hormone
replacement therapy on cardiovascular events in
recently postmenopausal women: randomised trial. BMJ
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