Secondary Prevention of Coronary Heart Disease in Women: A Call to Action

On the basis of extensive mechanistic evidence from in vitro and animal studies and clinical evidence from observational studies, it was predicted that postmenopausal hormone replacement therapy would protect women from coronary heart disease (CHD) events. However, the results of randomized, controlled trials available to date have not supported this prediction (1-3). In fact, the studies have shown evidence of harm—increased CHD events in the first year of treatment and increased stroke and venous thromboembolic events. Although these trials have acknowledged limitations, including use of only a single hormone preparation and participation of older women after many hormone-free years (a practice not usually followed in clinical care), the consistency of these results clearly does not support the use of postmenopausal hormones for prevention or treatment of CHD in women (4).

This leaves us with a growing population of middle-aged and elderly women who have lost the cardiovascular protection of their younger years and for whom unique sex-specific preventive and treatment strategies do not exist. Assessing risk and using effective preventive strategies in these women is critical: CHD is by far the leading cause of death, and deaths due to cardiovascular disease are increasing in American women despite advances in prevention and therapy (5). Women have higher mortality rates and are less likely to receive standard interventions after myocardial infarction than men (6). The prevalence of obesity and type 2 diabetes is increasing, particularly among African-American women, which also increases CHD risk …