Title: Primary prevention of coronary heart disease in women
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Primary prevention of coronary heart disease in women
British Menopause Society Council Consensus statement
Margaret Rees and John Stevenson on behalf of the British Menopause
Society Council
27 November 2007
Summary
The British Menopause Society Council is committed to provide up to date authoritative reviews to aid health professionals to inform and advise women about key issues in postreproductive health. Coronary heart disease (CHD) is a leading cause of death in women. Observational studies have consistently shown estrogen to help prevent CHD in postmenopausal women. The large randomized controlled Women’s Health Initiative (WHI) trial did not confirm these observational findings. However, further analyses of the WHI study as well as the observational Nurses’ Health Study have now found that the timing of onset of hormone replacement therapy (HRT) use is important and that estrogen may have a protective role in CHD in women aged 50 -59 years. This consensus statement will examine the evidence regarding HRT and non-estrogen therapies (lipid lowering agents, aspirin, antihypertensives, antidiabetic medications, SERMs) as well as diet, lifestyle and smoking cessation in the primary and secondary prevention of CHD in women.
Summary practice points
- estrogen may have a protective role in CHD prevention in women aged 50 -59 years
- women with a premature menopause should take estrogen to reduce the risk of CHD
- the role of lipid-lowering agents is uncertain
- aspirin cannot be recommended for primary prevention of CHD, but may protect against stroke
- treating hypertension reduces the risk of CHD
- in diabetics, prevention of CHD is based on management of established cardiovascular risk factors through both lifestyle measures and pharmacotherapy
- in metabolic syndrome, prevention of CHD is based on management of established cardiovascular risk factors through both lifestyle measures and pharmacotherapy
- stopping smoking, reducing obesity, improving diet and undertaking regular exercise are key lifestyle measures
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