Menopause and Risk of Cardiovascular Disease: Effects of Hormone Replacement Therapy

pp. 75-85

Abstract

Background

Cardiovascular disease is the leading cause of death in men and women in developing countries including Argentine. Women increase the risk to develop cardiovascular disease after menopause, generally7 to 10 years after the age men. During the fertile period women are protected against cardiovascular disease by the estrogen. Risk factors usually grow with the climacteric symptoms, then detection should be performed in women at early age, prior to menopause. Women do not have in mind this concept and the fear of cancer, especially breast cancer is commonly associated with the major cause of death.

Objectives

1) To investigate cardiovascular risk factors and/or cardiovascular disease in a cohort of menopausal women and their association with age and with time since menopause. 2) To evaluate their modification with differents treatments including hormone re-placement therapy during 4 years. 3) To analize the development of risk factors and/or cardiovascular disease during the follow up and the women's adherence to the treatmentsMaterial and methodA team of cardiologists and gynecologists, have evaluated 350 menopausal women for a period of 4 years. The patients were colected from the ginecologist department where they were being treated for climateric symptoms. They were evaluated by clinical report and a questionary ad hoc about risk factors and cardiovascular disease. Hormone replacement therapy or other treatments were performed when necessary. All the women where invited to participate in a epidemiological follow up, with a previous notification.

Results

We have demonstrated the relation between age and time since menopause with known cardiovascular risk factors as hypertension, dislipidaemia, obesity, diabetes, etc. Estrogen replacement therapy was used to correct and modify the menopause abnormalities. In our experience only 40.3%of the sample accepted this therapy; the rest of the population did not realize properly the epidemiological control for detection of cardiovascular diseases. We analized the effects and women's adherence to treatment in order to correct and prevent risk factors.

Conclusions

Menopause showed to be the period when known cardiovascular risk factor appeared. The hormonal changes seem to be a favorable field for risk factors growth. This finding explains why women with early menopause are at great risk for coronary disease. As in others parts of the world, women education about atherosclerotic disease is the objective of a great number of physicians in a effort to change the women's attitude toward prevention, and to convince them to accept proper treatments, not only hormone replacement therapy, for the con-trol of cardiovascular disease. These actions have to involve a group of faculty including ginecologist because women tend to considere them as a"house-hold doctors".