“Recently revised NCEP guidelines indicate that for women aged 45 to 75, the favorable effects of therapy with “statins” in clinical trials make a cholesterol-lowering drug preferable to HRT for CAD risk reduction”. Cleeman J. JAMA 2001;285(19):2486-97
Lipid-lowering therapy promotes clinically stable plaque- Prolonged intensive lipid-lowering therapy is associated with a markedly decreased lipid content in carotid atherosclerotic plaques- The clinical implication of this is that the low plaque lipid composition would predict greater plaque stability, and would thus reduce clinical ischemic events such as myocardial infarction or stroke. Zhao X-Q et al. Arterioscler Thromb Vasc Biol 2001;21:1623-1629,1563- 1564
“Lovastin together with continuous combined HRT seems to be more effective in the secondary prevention of coronary heart disease not only due to lipid lowering properties but also related to several other additive effects such as modification of endothelial function and inflammatory responses” El-Swefy SE et al. Pharmacological Research, 2002;45:167-173
Hormone Replacement Therapy concept To add hormones that shouldphysiologically be present at anytime in life
HRT must be changed to Postmenopause Hormone Treatments (PMHT)If Hormone Replacement Therapy isaccepted that would mean that allpostmenopausal women must begiven hormones.
If Hormone Replacement Therapy was a correct designation then this was no therapy at all but simply a replacement. It would not be a treatment for a disease but a restoration of what would be physiologic, which is not the case in the natural postmenopause.
PostMenopause Hormonal Treatments (PMHT) They are not substituiveThey are important for: - symptom relief - disease prevention (primary and secondary)
It must be made clear thatHRT does not mean that allwomen must be underhormonal treatments.
- The important issue, after all, is not HRT- What is important is the best possible approach to preventive medicine in a middle-aged woman
What is physiologic in thepostmenopause is a decline in theendocrine function of the ovary(hypoestrogenism). Therefore, there is nothing toreplace !
Thus, it is not physiologic to giveestrogens to all women, althoughestrogens are very importantpharmacologic agents to specificallytreat symptoms and to prevent diseasesthat are associated with/or caused bythe decrease of estrogens in thepostmenopause
“Pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to both prescribers and consumers” Moynihan R et al.BMJ 2002;324:886-90
“The social construction of illness is being replaced by the corporate construction of disease” Moynihan R et al.BMJ 2002;324:886-90
“Extending therapy to un-diseased population may also have important ethical implications, as treatment with statins may lead to perceptions of illness” Freemand X et al.BMJ 1998;316:1241
“IHD deaths are much more frequent in the USA than in Italy, whereas CeVD deaths are more common in Italy” Ricci S et al.J Clin Basic Cardiol 2002;5:105-108
“In the light of these differences, long-term HRT should yield larger benefits in North American women – with higher IHD mortality and lower incidence of fatal CeVD – and probably less beneficial effects in Italian women, who exhibit a lower IHD mortality and a higher CeVD mortality”. Ricci S et al.J Clin Basic Cardiol 2002;5:105-108
“Our analysis of age group mortality indicates that in the 40-49 age group for each woman dying of IHD, 5 will die of BC in Italy but only 2 in the USA” Ricci S et al.J Clin Basic Cardiol 2002;5:105-108
“Women who are to receive long-term HRT, should be selected much more carefully than in countries where IHD mortality is altogether higher and more frequent in younger women” Ricci S et al.J Clin Basic Cardiol 2002;5:105-108
Postmenopause (PMHT)Hormone Treatment is aconcept that means thatestrogens (and androgens) areto be used when indicated, inconjunction with other nonhormonal treatments and nonpharmacological strategies.
The gynecologists, or theendocrinologists are, above all, theinternists of the middle-aged womenthey accept to help.Either they know how to select andmanipulate several treatments, in aditionto hormones, or they must cooperateclosely with internists.
This discussion is important becausethere is a tendency to consider thatthere is nothing but estrogens tooffer to a postmenopausal woman,and that such treatments areobligatory for every woman and forvery long time. This is wrong !
Neves-e-Castro M-Tthe Queen is naked-Maturitas 2001;38:235-7