Prévention des troubles coronaires par le traitement hormonal précoce à la ménopause : une idée qui s'impose à nouveau

The important controversy concerning the potential beneficial, neutral or unfavourable effect of estrogens or estrogen plus progestin on the risk of coronary heart disease in postmenopausal women is beginning to settle down. Reanalysis of large observational and randomized trials according to age and years since menopause and recent additional studies allow to positively state that postmenopausal hormone therapy - and particularly estrogens alone - is safe and effective. For instance, in the Women's Health Initiative study, provided hormone therapy is initiated within 10 years since menopause, a reduction of the risk of coronary heart disease by 12 to 52% according to the use of estrogen plus progestin or estrogen alone, respectively, is observed versus placebo use. Global mortality is also reduced by 30% with both hormone therapies. This favourable effect is not observed when treatment is initiated in older postmenopausal women. These important and reassuring data should encourage regulatory authorities to reassess clinical recommendations in that prospect.