Coronary Artery Disease and Hormone Replacement Therapy for Menopausal Symptoms

Evidence Against Using HRT in Women with CAD

The American Heart Association suggests that HRT should not be initiated for secondary prevention of cardiovascular disease in women with established CAD, due to increased cardiovascular risks 1, 3
The Heart and Estrogen/progestin Replacement Study (HERS) demonstrated no reduction in cardiovascular events with HRT in women with CAD and found an increased risk of cardiac events in the first 1-2 years of therapy, as reported by the American College of Cardiology 4, 2

The American College of Cardiology recommends that if a woman develops an acute coronary event while on HRT, it is prudent to discontinue the therapy, considering the severity of menopausal symptoms and established non-coronary benefits and risks 5, 2
For women with CAD who have been on long-term HRT, the decision to continue or stop should be based on the severity of menopausal symptoms, established non-coronary benefits and risks, and patient preference after informed discussion, according to the American Heart Association 6, 1

The American College of Obstetricians and Gynecologists suggests that non-hormonal pharmacological options should be considered first-line therapy for vasomotor symptoms, and locally applied vaginal estrogen may be considered for genitourinary symptoms as there is minimal systemic absorption 6
If severe vasomotor symptoms cannot be managed with non-hormonal treatments and significantly impact quality of life, consider consultation with both cardiovascular and menopause specialists, and use the lowest effective dose for the shortest possible time, as recommended by the North American Menopause Society 6

The American Heart Association recommends regular reassessment of the risk-benefit ratio is essential if HRT is used, and women with CAD should be managed with evidence-based therapies including lipid-lowering agents, antiplatelet therapy, beta-blockers, and ACE inhibitors 4, 8
Lifestyle modifications remain cornerstone therapy, including smoking cessation, regular physical activity, optimal weight management, and heart-healthy diet, as suggested by the American College of Cardiology 4, 2