ACOG Committee Opinion No. 565: Hormone therapy and heart disease - PubMed (original) (raw)
Practice Guideline
ACOG Committee Opinion No. 565: Hormone therapy and heart disease
No authors listed. Obstet Gynecol. 2013 Jun.
Abstract
Menopausal hormone therapy should not be used for the primary or secondary prevention of coronary heart disease at the present time. Evidence is insufficient to conclude that long-term estrogen therapy or hormone therapy use improves cardiovascular outcomes. Nevertheless, recent evidence suggests that women in early menopause who are in good cardiovascular health are at low risk of adverse cardiovascular outcomes and should be considered candidates for the use of estrogen therapy or conjugated equine estrogen plus a progestin for relief of menopausal symptoms. There is some evidence that lends support to the "timing hypothesis," which posits that cardiovascular benefit may be derived when estrogen therapy or hormone therapy is used close to the onset of menopause, but the relationship of duration of therapy to cardiovascular outcomes awaits further study. Clinicians should encourage heart-healthy lifestyles and other strategies to reduce cardiovascular risk in menopausal women. Because some women aged 65 years and older may continue to need systemic hormone therapy for the management of vasomotor symptoms, the American College of Obstetricians and Gynecologists recommends against routine discontinuation of systemic estrogen at age 65 years. As with younger women, use of hormone therapy and estrogen therapy should be individualized based on each woman's risk-benefit ratio and clinical presentation.
Similar articles
- ACOG Committee Opinion No. 420, November 2008: hormone therapy and heart disease.
American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Obstet Gynecol. 2008 Nov;112(5):1189-92. doi: 10.1097/AOG.0b013e31818e8782. Obstet Gynecol. 2008. PMID: 18978127 - The timing hypothesis: Do coronary risks of menopausal hormone therapy vary by age or time since menopause onset?
Bassuk SS, Manson JE. Bassuk SS, et al. Metabolism. 2016 May;65(5):794-803. doi: 10.1016/j.metabol.2016.01.004. Epub 2016 Jan 12. Metabolism. 2016. PMID: 27085786 Free PMC article. Review. - Invited commentary: hormone therapy and risk of coronary heart disease why renew the focus on the early years of menopause?
Manson JE, Bassuk SS. Manson JE, et al. Am J Epidemiol. 2007 Sep 1;166(5):511-7. doi: 10.1093/aje/kwm213. Epub 2007 Jul 23. Am J Epidemiol. 2007. PMID: 17646204 - Comparative cardiovascular effects of different progestins in menopause.
Rosano GM, Fini M. Rosano GM, et al. Int J Fertil Womens Med. 2001 Sep-Oct;46(5):248-56. Int J Fertil Womens Med. 2001. PMID: 11720197 Review. - Cardiovascular health and the menopausal woman: the role of estrogen and when to begin and end hormone treatment.
Naftolin F, Friedenthal J, Nachtigall R, Nachtigall L. Naftolin F, et al. F1000Res. 2019 Sep 3;8:F1000 Faculty Rev-1576. doi: 10.12688/f1000research.15548.1. eCollection 2019. F1000Res. 2019. PMID: 31543950 Free PMC article. Review.
Cited by
- Assessing and Modifying Coronary Artery Disease Risk in Women.
Sarma A, Scott NS. Sarma A, et al. Curr Treat Options Cardiovasc Med. 2017 Jul;19(7):51. doi: 10.1007/s11936-017-0554-2. Curr Treat Options Cardiovasc Med. 2017. PMID: 28523440 Review. - Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review.
Cho L, Davis M, Elgendy I, Epps K, Lindley KJ, Mehta PK, Michos ED, Minissian M, Pepine C, Vaccarino V, Volgman AS; ACC CVD Womens Committee Members. Cho L, et al. J Am Coll Cardiol. 2020 May 26;75(20):2602-2618. doi: 10.1016/j.jacc.2020.03.060. J Am Coll Cardiol. 2020. PMID: 32439010 Free PMC article. Review. - Prescribing of FDA-approved and compounded hormone therapy differs by specialty.
Constantine GD, Archer DF, Graham S, Bernick BA, Mirkin S. Constantine GD, et al. Menopause. 2016 Oct;23(10):1075-82. doi: 10.1097/GME.0000000000000683. Menopause. 2016. PMID: 27648594 Free PMC article. - The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman.
Mulvagh SL, Mullen KA, Nerenberg KA, Kirkham AA, Green CR, Dhukai AR, Grewal J, Hardy M, Harvey PJ, Ahmed SB, Hart D, Levinsson ALE, Parry M, Foulds HJA, Pacheco C, Dumanski SM, Smith G, Norris CM. Mulvagh SL, et al. CJC Open. 2021 Sep 25;4(2):115-132. doi: 10.1016/j.cjco.2021.09.013. eCollection 2022 Feb. CJC Open. 2021. PMID: 35198930 Free PMC article. Review. - Female-specific factors for IHD: across the reproductive lifespan.
Shufelt C, Waldman T, Wang E, Merz CN. Shufelt C, et al. Curr Atheroscler Rep. 2015;17(2):481. doi: 10.1007/s11883-014-0481-6. Curr Atheroscler Rep. 2015. PMID: 25620277 Review.
References
- Barrett-Connor E, Bush TL. Estrogen and coronary heart disease in women. JAMA 1991;265:1861–7.
- Grady D, Rubin SM, Petitti DB, Fox CS, Black D, Ettinger B, et al.. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med 1992;117:1016–37.
- Barrett-Connor E, Grady D. Hormone replacement therapy, heart disease, and other considerations. Annu Rev Public Health 1998;19:55–72.
- Grodstein F, Manson JE, Colditz GA, Willett WC, Speizer FE, Stampfer MJ. A prospective, observational study of post-menopausal hormone therapy and primary prevention of cardiovascular disease. Ann Intern Med 2000;133:933–41.
- Psaty BM, Heckbert SR, Atkins D, Lemaitre R, Koepsell TD, Wahl PW, et al.. The risk of myocardial infarction associated with the combined use of estrogens and progestins in post-menopausal women. Arch Intern Med 1994;154:1333–9.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Research Materials