WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

CHAPTER 8: CARDIOVASCULAR AND PULMONARY DISEASE
Peter Collins, M.D.;* Nanette K. Wenger, M.D.; † Jacques E. Rossouw, M.D.; ‡ and Rodolfo Paoletti, M.D. §
KEY POINTS a
1. CVD is the commonest cause of morbidity and mortality in women [C].
CVD is the commonest
2. The risk factors contributing to CVD are generally the same in women and men,
with the possible exception of hormonal effects [C].
cause of morbidity and
3. Evidence-based medicine has demonstrated that beta-blockers, aspirin, statins, mortality in women.
and ACE inhibitors can reduce the risk of cardiovascular events in women. The
main causes, prevention, and treatment of CVD in women are similar to those in men [A].
4. Although the use of HRT has been associated with a lower risk of CVD in epidemiological studies, this has
not been borne out in clinical trials to date [C].
5. Until the long-term benefit of HRT is proven, attention should focus on identifying and treating the same
risk factors in women as in men [A].
1. INTRODUCTION
CVD afflicts more women than any other disease.
It is by far the commonest cause of morbidity and
mortality in women, and there is a steep increase in
the incidence of CVD with age, especially after
menopause. Ovarian hormones are thought to be
protective of the cardiovascular system; 17β-estradiol
and progesterone. Hormones that are effective
* From Cardiac Medicine, NHLI, Imperial College School of Medicine, London, United Kingdom.
† From Emory University School of Medicine, Atlanta, GA, U.S.A.
‡ From the WHI, NHLBI, NIH, Bethesda, MD, U.S.A.
§ From the Department of Pharmacological Sciences, University of Milan, Milan, Italy.
for the short-term treatment of symptoms of perimenopause
may not necessarily be the best choices
for preventing CVD. HRT is not a single entity but
encompasses a diverse number of agents, which
may have differing effects on the cardiovascular
system. It is therefore important, from a public
health standpoint, to perform studies using different
a Evidence categories are given in square brackets. A = randomized controlled trials (rich body of data); B = randomized controlled trials (limited data);
C = nonrandomized trials and observational epidemiologic studies; D = Panel expert judgment. (See also table 1–1.)
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