Menopause and cardiovascular disease

Cardiovascular disease (CVD) in women can be influenced by endogenous and exogenous hormones. For both sexes, the risk of CVD shows a linear increase with age, but at all ages CVD is less frequent in women than in men. Menopause influences risk factors for CVD because it increases total serum cholesterol by 2–20% and triglycerides by 7–35%, independent of age, while it is also associated with significant increases in antithrombin III, factor VII coagulant activity VIIc and plasma fibrinogen. After menopause, an increase in the waist—hip ratio can be observed. However, menopause is not known to have an effect on blood pressure. Surgical menopause as well as early natural menopause are therefore independent risk factors for cardiovascular mortality. Each year of delayed menopause represents a 2% reduction in the annual hazard of death due to CVD. The effect of early menopause may be more important at younger ages. Numerous studies on the effect of exogenous hormones and the risk of CVD have shown a 30–50% reduction of CVD in estrogen users. The main problem when attempting to interpret these observations is that the effect of selection and compliance bias is unknown to us. Randomized trials are therefore still needed to justify primary and secondary prevention achieved by estrogen administration in postmenopausal women. The effect of estrogens, or progestin, or both on the risk of CVD have been reported. Estrogens alone or combined with progestin improve the serum lipoprotein profile and lower fibrinogen levels, but their effects on clinical outcome are still unknown.