Direct Estrogen Effects on the Cardiovascular System

TLDR: Using data collected from the Nurses Health Study, Grodstein et al. reported that hormone replacement therapy (estrogen or estrogen/progestin) decreased the risk of cardiovascular disease in postmenopausal women by approx 50%.

Abstract: Coronary artery disease (CAD) is the leading cause of death among women (1). The risk of CAD is low in premenopausal women and increases dramatically after menopause. Data from the Framingham Heart Study assessed sex-specific patterns of CAD and demonstrated that although men were at greater risk of heart disease than women at all ages, the difference in risk diminished as the participants got older, mainly because of a surge in the number of coronary events in women after age 45 (2). Whether this increased risk in women is a result of menopause with its associated loss of hormonal protection versus confounding factors such as aging has been debated. Observational studies have shown major reductions (approx 50%) in risk for CAD in postmenopausal women who take replacement estrogen or combined estrogen/progestin preparations (3). The largest of these, the Nurses Health Study, was established in 1976, when 121,700 female nurses between 30 and 55 years of age completed a questionnaire documenting their medical history and lifestyle. Every two years, followup questionnaires were sent out to update risk factors and new disease. Using data collected from this study, Grodstein et al. reported that hormone replacement therapy (estrogen or estrogen/progestin) decreased the risk of cardiovascular disease in postmenopausal women by approx 50% (4).