Cardiovascular disease

This includes high blood pressure (hypertension), coronary heart disease (myocardial infarction) or history of stroke.

WOMEN WITH RISK FACTORS FOR CARDIOVASCULAR DISEASE:

• NICE says that the presence of cardiovascular risk factors is not a contraindication to taking HRT as long as they are optimally managed.

WOMEN WITH A PAST HISTORY OF CORONARY HEART DISEASE OR STROKE:

• There is a lack of evidence to guide clinical practice on the use of HRT following myocardial infarction or stroke, and the decision should be made on an individualised basis.
• NICE says for people with a history of coronary heart disease or stroke, ensure that combined or oestrogen only HRT is discussed with and, if appropriate, initiated by a health care professional with expertise in menopause.

• Very few studies have looked at the effect of HRT on pre-existing atherosclerotic plaques and any risk of subsequent plaque destabilisation. This is not well understood and represents an ongoing area of uncertainty.
• Low-quality data suggests oral oestrogens might increase the risk of plaque rupture by increasing matrix metalloproteinases (MMP).
• Whether or not transdermal HRT does this too is not known.