Menopause and the Risk of Cardiovascular Diseases
Pp. 126-142 (17)
Cardiovascular disease is the major cause of mortality in women and in men.
The incidence of cardiac events in women is lower than in men during the fertile age but
increases after menopause. Sex hormones exert significant effects on the cardiovascular
system and ovarian hormone deficiency associated with menopause may play an important
role in the development of cardiovascular diseases. The reduced risk of cardiovascular
diseases associated with hormone replacement therapy, reported in the observational
studies, has not been subsequently confirmed in the randomized clinical trials. Thus,
hormone replacement therapy is not recommended for cardiovascular prevention. It is
extremely important to carefully assess the risk of cardiovascular diseases in women in the
peri- and postmenopausal period, in order to develop appropriate prevention strategies.
Risk assessment should be extended to older age groups in order to account for the delayed
onset of cardiovascular diseases in women. Some therapeutic options may not be equally
effective and safe in men and women. However, under-representation of women in
cardiovascular research has been demonstrated. The EuroHeart project showed that the 62
randomized clinical trials published between 2006 and 2009 enrolled 33.5% of women and
only 50% of the trials reported the analysis of the results by gender. Cardiovascular clinical
trials enrolling a significant proportion of women to allow for pre-specified gender analysis
should be conducted. Enrolment criteria and follow-up duration should allow the inclusion
of women at risk of developing cardiac events.
Women, menopause, age, cardiovascular disease, cardiovascular risk
score, smoking, hypertension, hyperlipidemia, diabetes, prevention, sex
hormones, hormone replacement therapy, observational studies, randomized
controlled trials, guidelines.
Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Via Mosè Bianchi, 90, 20149 Milan, Italy