Learning Objectives

1. Understand the mechanisms behind the increase in cardiovascular risk around menopause

2. Review the Women's Health Initiative study and how it impacted the perception of hormone therapy risk

3. Understand the parameters for reduced risk in prescribing hormone therapy 

Part 1 of this lesson reviews the physiological changes that occur with aging and the menopause transition that increase the risk of heart disease. Many clinicians are aware that heart disease risk increases with age, and that there is a more pronounced increase over the menopause transition. This lecture will help clinicians identify additional risk factors that make cardiovascular disease risk higher in certain patients during and after menopause. The importance of lifestyle intervention counseling is reviewed, as well as thresholds for treatment of hypertension and hyperlipidemia.

Part 2 reviews the history of the Women’s Health Initiative and research into hormone therapy and cardiovascular risk. The WHI was initiated after observational studies found that women on menopause hormone therapy (MHT) had fewer heart attacks, strokes, and less cardiovascular disease overall. Review of the WHI data and subsequent studies shows that MHT is associated with a lower risk of almost every form of cardiovascular disease. The current debate is whether MHT should be recommended as prevention for those at high risk of heart disease. At this point, each provider needs to make their own informed decision, and this review of the research will help you best support your patients.