Estrogen replacement therapy and coronary artery disease

Coronary artery disease (CAD) is the number one cause of death and disability in women and men in the United States. In women, CAD typically develops after menopause, and, therefore, it has been hypothesized that estrogen replacement therapy (ERT) may have a role in preventing and treating CAD. Indeed, a body of epidemiologic data suggests that estrogen does protect against CAD. Much information is also available on the mechanisms by which estrogen may confer protection versus CAD. For example, ERT has been shown to have an overall beneficial effect on cardiac risk factors such as hyperlipidemia in postmenopausal women, but the degree to which ERT affects the lipid profile and other risk factors is relatively modest and does not seem to account for all of the benefits of estrogen. Thus, this review focuses not only on the effects of ERT on cardiac risk factors but also on other aspects of CAD, such as atherogenesis, lipid oxidation, vasomotor tone, and thrombosis and thrombolysis. The recent literature on the effect of ERT on secondary prevention of cardiovascular events after percutaneous coronary interventions or coronary artery bypass surgery is also reviewed.