Cardiovascular disease

The baseline risk of cardiovascular disease for women varies from one woman to another according to the presence of cardiovascular risk factors.

• There is evidence available that suggests that HRT (oestrogen with or without a progestogen) started before the age of 60 years or within 10 years of the menopause is associated with a reduction in atherosclerosis progression, coronary heart disease and death from cardiovascular causes.
• This has been termed the cardiovascular timing hypothesis or the cardiovascular window of opportunity.
• NICE highlights however that findings from RCT data have been inconsistent. NICE concludes that overall combined HRT or oestrogen only HRT does not increase risk of coronary heart disease or mortality from cardiovascular disease.

• 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.