The cardiovascular risk of postmenopausal hormone replacement therapy is a controversial subject. A quantitative evaluation of 12 studies of cohorts show a global relative risk of major ischemic ...cardiac disease of 0.69 (95% confidence interval: 0.60-0.79) in women having or having had oestrogen therapy compared with women who have never taken this treatment. This relative risk was 0.94 (95% confidence interval: 0.77 to 1.15) for stroke and 0.80 (95% confidence interval: 0.65-0.97) for cardiovascular mortality. These results are coherent with the hypothesis of a protective effect of oestrogens against coronary artery disease in postmenopausal women. However, they cannot be generalised to hormone replacement therapy usually proposed in France. The influence of an association of oestrogen-progesterone therapy and the effects of administering oestrogens by an extra-gastrointestinal route on vascular risk are unknown. Randomised clinical trials are needed to determine the effects of postmenopausal hormone replacement therapy on athero-thrombotic disease.
The extension of hormonal replacement therapy to all women after their menopause as a preventive action is becoming a major public health issue. Cost-effectiveness analysis represents an appropriate ...tool to address the economical aspects of this issue. Out of the 3 studies reported in the past recent years on this topic, the Oxford Hormone Therapy Group study is the only one to take into account all possible outcomes of the hormonal replacement therapy. Its conclusions, however, cannot be extended directly to other countries, as the hormonal replacement therapy may differ in many aspects, like: 1) the chemical nature, metabolism and mode of administration of the hormones used, both as regard the oestrogen component and the progestative one; 2) the acceptability of the therapy in relation to its side effects; 3) the age-specific morbi-mortality data in relation to hip fractures, breast cancer and cardiovascular diseases.
