Hormone replacement therapy and the association with coronary heart disease and overall mortality: Clinical application of the timing hypothesis

  title={Hormone replacement therapy and the association with coronary heart disease and overall mortality: Clinical application of the timing hypothesis},
  author={Howard N. Hodis and Wendy Jean Mack},
  journal={The Journal of Steroid Biochemistry and Molecular Biology},
  • H. Hodis, W. Mack
  • Published 1 July 2014
  • Medicine
  • The Journal of Steroid Biochemistry and Molecular Biology
Hormone therapy in menopause: An update on cardiovascular disease considerations.
Primary prevention of cardiovascular disease with hormone replacement therapy
  • L. Schierbeck
  • Medicine
    Climacteric : the journal of the International Menopause Society
  • 2015
The beneficial effects of HRT, with emphasis on cardiovascular disease are explained, and the relative and absolute risks of side-effects are discussed.
A heartfelt message, estrogen replacement therapy: use it or lose it.
The issue of cardiovascular and cognitive health in women is complex. During the premenopausal phase of life, women have healthy blood pressure levels that are lower than those of age-matched men,
Menopausal Hormone Therapy, Age, and Chronic Diseases: Perspectives on Statistical Trends
  • J. Bolton
  • Medicine
    Chemical research in toxicology
  • 2016
A Perspective on Statistical Trends evaluates the current data on HT and risk for chronic diseases as a function of age and suggests that younger women (50–60) may be protected from heart disease with only a slight increase in breast cancer risk and older women (>65) are more susceptible to breast cancer and heart disease and should avoid HT.
The effect of hormone therapy on all-cause and cardiovascular mortality in women with chronic kidney disease: protocol for a systematic review and meta-analysis
This study will help guide clinical practice by summarizing current evidence on the use of hormone therapy for prevention of all-cause mortality, cardiovascular mortality, and cardiovascular morbidity in this population of women with chronic kidney disease.
A Mechanistic Hypothesis to Explain the Timing Hypothesis
The timing hypothesis provides guidance for future clinical care of menopausal women but does not address the underlying physiologic basis or mechanistic difference in either the timing or the HT regimen, however, longitudinal epidemiological data collected from mid-aged women and experimental studies in nonhuman primates provide additional information that may permit the associations found in population-based studies to hypothesize a causal pathway.
Prescribing menopausal hormone therapy: an evidence-based approach
For women under the age of 60 years, or within 10 years of onset of natural menopause, MHT for the treatment of bothersome menopausal symptoms poses low risk and is an acceptable option, particularly when nonhormonal management approaches fail.
Timing of Estradiol Treatment After Menopause May Determine Benefit or Harm to Insulin Action.
E2-mediated effects on insulin action may be one mechanism by which HT reduces the incidence of T2D in early postmenopausal women, and there was an apparent benefit early (≤ 6 years) compared to harm later (≥ 10 years) in menopause.
Cardiovascular and sexual health effects of postmenopausal testosterone therapy
It is suggested that short-term physiological testosterone does not adversely affect arterial stiffness and may improve markers of endothelial function and testosterone use was associated with reductions in HDL cholesterol and lipoprotein, but whether this has significant long-term CV effects remains unclear.


The timing hypothesis for coronary heart disease prevention with hormone therapy: past, present and future in perspective
Cumulated data support a ‘window-of-opportunity’ for maximal reduction of CHD and overall mortality and minimization of risks with HRT initiation before 60 years of age and/or within 10 years of menopause and continued for 6 years or more.
Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause.
Whether the effects of hormone therapy on risk of cardiovascular disease vary by age or years since menopause began is explored to explore and women who initiated hormone therapy closer toMenopause tended to have reduced CHD risk compared with the increase inCHD risk among women more distant from menopausal symptoms.
Combined postmenopausal hormone therapy and cardiovascular disease: toward resolving the discrepancy between observational studies and the Women's Health Initiative clinical trial.
Hazard ratio estimates for coronary heart disease, stroke, and venous thromboembolism in the observational study were 39-48% lower than those in the clinical trial following age adjustment, although there was evidence of some remaining difference for stroke.
A Prospective, Observational Study of Postmenopausal Hormone Therapy and Primary Prevention of Cardiovascular Disease
The relation among low-dose estrogen, short-term hormone use, and cardiovascular events in 70 533 postmenopausal women with no previous cardiovascular disease who were followed for up to 20 years is examined.
Estrogen in the Prevention of Atherosclerosis
The primary hypothesis was that unopposed ERT significantly reduces the progression of subclinical atherosclerosis in healthy postmenopausal women without preexisting cardiovascular disease.
Postmenopausal hormone therapy and stroke: role of time since menopause and age at initiation of hormone therapy.
Hormone therapy is associated with an increased risk of stroke, and this increased risk does not appear to be related to the timing of the initiation of HT, in younger women, with lower stroke risk.
Brief report: Coronary heart disease events associated with hormone therapy in younger and older women
AbstractOBJECTIVE: To assess the effect of hormone therapy (HT) on coronary heart disease (CHD) events in younger and older postmenopausal women. DESIGN: A comprehensive database search identified
Effect of body mass on the association between estrogen replacement therapy and mortality among elderly US women.
The association between postmenopausal estrogen use and all-cause, coronary heart disease, stroke, all-cancer, and breast cancer death rates and whether these associations differed by body mass was examined in 290,827 post menopausal US women.
Postmenopausal estrogen and progestin use and the risk of cardiovascular disease.
The addition of progestin does not appear to attenuate the cardioprotective effects of postmenopausal estrogen therapy, and there was no significant association between stroke and use of combined hormones.