Traitement hormonal substitutif de la ménopause et risque vasculaire

Although experimental data and results of observational studies suggest that hormone replacement therapy (HRT) was associated with a reduction in the risk of heart disease, the results for stroke have been far less clear. Several recent randomized secondary prevention studies have found that HRT is not protective against the risk of coronary heart disease, stroke or progression of atherosclerosis. Moreover, an increased risk of stroke and first coronary event with hormone therapy has been found in low-risk healthy post menopausal women. In light of these findings, although the absolute risk of vascular event associated with HRT is low, most organizations recommend caution in using HRT. Hormone therapy should not be initiated to prevent vascular disease among postmenopausal women. There are numerous plausible explanations for the divergent findings from observational and randomized clinical trials of hormone therapy. Some discrepancies are certainly the result of methodological differences between the study designs. They also suggest other biological effects of hormone therapy than modification of classic vascular risk factors. Further studies should focus on identifying the mechanisms of risk and determining whether and how different regimens of hormone therapy influence vascular risk.