Despite the obvious predominance of
coronary heart disease in middle-aged men,
cardiovascular disease including
coronary heart disease and
cerebrovascular accidents is currently the major cause of death in women (54% cardiovascular mortality, 46% coronary mortality; 28% of all deaths). Before menopause,
coronary heart disease is infrequent which suggests that female
hormones and metabolism offer protection. Without
hormone replacement therapy after menopause women may develop
coronary atherosclerosis. Ageing is among the non-modifiable risk factors for
coronary heart disease in women, while
genetic predisposition and environmental factors remain controversial. The modifiable risk factors are mostly common to both sexes and include heavy cigarette smoking (especially in women under oral
contraception) dyslipidaemia,
high blood pressure, and diabetes; some factors are peculiar to women. The delayed onset of
coronary heart disease in women, roughly 10 years later than in men, and greater feminine longevity (81 years vs 74 in men on average) points to the potential benefit of post-menopause
hormone replacement therapy together with reduction of other modifiable risk factors. After menopause, the protective
HDL cholesterol decreases whereas high
LDL cholesterol, high
triglycerides and
high blood pressure are major risk factors for
coronary heart disease as well as for
cerebrovascular accident. The role of
hormone replacement therapy in the prevention of
cardiovascular disease in women is still controversial despite the results of meta-analyses which suggest a 25% to 44% reduction in
coronary heart disease following oestrogen
therapy alone or in combination with
progestogen, depending on the hormonal regime. In conclusion, menopause, now considered as the marker for the end of natural protection against
coronary heart disease, should be followed by early and prolonged combined
hormone replacement therapy in order to reduce the low compliance with long-term
hormone replacement therapy.