Menopause-cardiology consensus statement on cardiovascular disease and on HRT

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1. Many women and their doctors are unaware of the cardiovascular dangers facing women going through and after the menopause. Awareness of the dangers needs to be raised; CVD is the number-one killer of women in the Western world and women should be assessed for CVD and the risk factors for CVD on visits to their gynaecologist.

2. The effects of hormone replacement therapy (HRT) on CVD are favourable, although these depend on the woman's age and medical background. There is a trend that HRT is cardioprotective in younger women. In older women, there is a trend to an increase in CVD risk, although this effect is not statistically significant. In general, HRT is safe for most younger women (i.e. women going through the menopause or in the early postmenopausal period) for the relief of menopausal symptoms.

3. Women older than 60 years, or those with predisposing risk factors, have a very slightly increased CVD risk and should be more cautious. HRT is also known slightly to increase the risk of venous thromboembolism. Overall, however, these risks are small and shouldn't deter women consulting their clinician about whether HRT is suitable for them. It is important that all women discuss their medical history with their clinician before deciding to take HRT.

Professor Roger Lobo (Columbia University, New York), said:

"This was an unique conference which was held between the International Menopause Society and European cardiologists. It critically reviewed the importance of hypertension and CVD in post menopausal women, and the safety and efficacy in prescribing HT in symptomatic younger post menopausal women. The conclusions of the conference need to be noted and where circumstances allow, incorporated into clinical practice".

Dr David Sturdee, Joint Chair of the Workshop and President of the IMS, said:

"This is an important statement, given the concern that was expressed over cardiovascular disease risk when the WHI study was halted in 2002.

Cardiovascular disease is the number-one killer of women in the western world, with around half of women dying from heart attacks, embolisms, thrombosis and stroke. Women are rightly aware of the risks of breast cancer but breast cancer kills 1 in 26, yet CVD is invisible to many women. We want to make evaluation of cardiovascular risk at the menopause a standard part of a gynaecological consultation.

It's vitally important that women are checked for cardiovascular risk factors, and that gynaecologists take the opportunity to look at the cardiovascular health of each woman as she approaches and goes through the menopause. Advice on a healthier lifestyle and cardiovascular treatment should be considered alongside any treatment to help women through the menopause."

Professor Peter Collins (Professor of Clinical Cardiology at the UK's National Heart and Lung Institute, Imperial College and Royal Brompton Hospital and Chair of the European Society of Cardiology's Task Force on Gender), who was also a Chair of the Workshop said:

"As regards HRT, around the time of the menopause, it has a slight beneficial effect on the cardiovascular system. If you take HRT 10 years after the menopause, it appears to have a negative effect on the cardiovascular system, but it is important to note, as the WHI indicated when re-analysing its data***, this negative effect is of marginal significance. The Workshop's message on HRT would be, if you are in reasonable health, aged 50--59 and you take it for relief of menopausal symptoms, then there is little evidence to support that it has any negative cardiovascular effects.

The important thing is to talk over HRT use with your doctor before starting to make sure that it's right for you. For some women, it's not appropriate, but for most women it improves the quality of their lives while going through the menopause."

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Notes

* i.e. Those related to arterial disease (atherosclerosis).

** The Workshop Ageing, menopause, cardiovascular disease and HRT was held in Pisa, Italy in February 2009. The Workshop was organised by the International Menopause Society, with the participation of the Task Force on Gender of the European Society of Cardiology. The full consensus statement can be found at: http://www.imsociety.org/pdf_files/position_papers/ims_consensus_statement_2009.pdf

Detailed conclusions of the workshop, as well as information on the writing group, participants, conflict of interest, funding, etc, can be found at this site. The full statement is also available as a pdf from ims@parkhill.it

*** Re-analysis of the WHI data, see (1) Rossouw JE, Prentice RL, Manson JE, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007;297:1465-77, and (2) Manson JE, Allison MA, Rossouw JE, et al. Estrogen therapy and coronary-artery calcification. N Engl J Med 2007;356:2591-602

International Menopause Society