Cardiovascular risk in women: the impact of hormone replacement therapy and prospects for new therapeutic approaches

Cardiovascular disease (CVD) is the main cause of death in women. Observational studies of hormone replacement therapy (HT) and data from women with premature ovarian failure have provided support for the principle that estrogen confers protection against the development of CVD in premenopausal women. However, randomised, controlled trials investigating HT in postmenopausal women have failed to demonstrate a benefit of HT in the primary or secondary prevention of CVD. Nevertheless, HT may be effective if targeted at younger perimenopausal women. Research aimed at investigation of the cellular mechanisms of estrogen may result in the discovery of new therapeutic targets that may be able to harness the potential beneficial effects of estrogens in the cardiovascular system. An improved understanding of the distinct processes in the clinical presentation and progress of CVD in women will help develop new targets and enhance the use of current established drugs.