Cardiovascular disease (CVD) is the leading cause of death in the United States, with coronary heart disease (CHD) being the single leading cause of death and a significant cause of morbidity among American women. Risk factors for CHD are well documented, and much of the data available indicates that this disease is, for the most part, preventable. Unfortunately, research indicates that CHD in women remains significantly underdiagnosed, much more so than in men.
Women and their physicians often fail to relate chest pain to CVD, despite the fact that postmenopausal women are at increased risk. This issue of Advanced Studies in Medicine addresses the emerging trends in the management of CVD in postmenopausal women.
Until recently, hormone replacement therapy (HRT) was considered an appropriate treatment of menopausal symptoms that provided a degree of cardioprotective benefit as well as prevention of osteoporosis. Newly published studies have raised significant concern in the medical community as well as the general patient population regarding the appropriate use of HRT and its risks in postmenopausal women.
A reprint of the article, "Raloxifene and Cardiovascular Events in Osteoporotic Postmenopausal Women: Four-Year Results From the MORE (Multiple Outcomes of Raloxifene Evaluation) Trial," is also included in this issue, providing promising information on a drug currently used for prevention and treatment of osteoporosis. Raloxifene's effects on risk for cardiovascular events in postmenopausal women with documented coronary disease or at increased risk for CVD is currently being tested prospectively in the Raloxifene Use for the Heart (RUTH) trial, although results will not be available for several years.
This issue includes 2 abstracts from recently published studies on HRT in postmenopausal women: the Women's Health Initiative (WHI) findings and the Heart and Estrogen/Progestin Replacement Study follow-up (HERS II). These studies are discussed in depth in a question-and-answer session with Nanette K. Wenger, MD. Dr Wenger provides important information about the diagnosis and management of CHD in postmenopausal women. Also discussed is the traditional use of hormone therapy and how recommendations have changed based on current and ongoing research.
Dr Wenger also explains the value of studies such as the RUTH trial, which is currently under way, and how information from all of these studies can be used by the practicing physician to determine appropriate management of postmenopausal women, including women with osteoporosis, or with CHD risk factors or CHD, and those with a combination of these conditions.
In another question-and-answer session, we explore the prevalence of CHD and its risk factors in postmenopausal women and how primary care physicians counsel their patients regarding these issues. Unfortunately, counseling is an area of missed opportunity for many physicians, and the reasons for this are discussed. Methods of minimizing and preventing cardiovascular risk factors are reviewed, and current recommendations for lipid-lowering therapy and lifestyle changes are given based on the latest research, including information from the National Cholesterol Education Program Adult Treatment Panel guidelines.
Finally, 2 case studies are provided to address current concepts of managing CVD and its risk factors in postmenopausal women. Patients and physicians are dealing with a rapidly changing landscape in the area of hormone therapy, with good scientific information continuing to emerge from rigorous, ongoing clinical trials. The case studies incorporate some of these current issues and, along with the other material presented, are designed to strongly encourage physicians to counsel women regarding hormone therapy based on the most current and appropriate scientific information.
*Director, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and Associate Professor of Medicine, Department of Cardiology, Johns Hopkins University; School of Medicine, Baltimore, Maryland.