The Impact of Hormone Replacement Therapy on the Pathophysiology of Peripheral Arterial Disease

Background Hormone replacement therapy (HRT) is recommended to post-menopausal women to control menopausal symptoms and prevent osteoporosis. The management of women with peripheral arterial disease (PAD) and who are taking HRT is controversial. Aim To summarise what is known about HRT and its effec...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2007-11, Vol.34 (5), p.569-575
Main Authors: Davies, R.S.M, Vohra, R.K, Bradbury, A.W, Adam, D.J
Format: Article
Language:English
Subjects:
Atherosclerosis - physiopathology
Atherosclerosis - prevention & control
Disease Progression
Endothelium, Vascular - physiopathology
Estrogen Replacement Therapy
Estrogens - administration & dosage
Estrogens, Conjugated (USP) - administration & dosage
Female
Hormone replacement therapy
Humans
Middle Aged
Peripheral vascular disease
Peripheral Vascular Diseases - physiopathology
Peripheral Vascular Diseases - prevention & control
Progesterone - administration & dosage
Surgery
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Summary:Background Hormone replacement therapy (HRT) is recommended to post-menopausal women to control menopausal symptoms and prevent osteoporosis. The management of women with peripheral arterial disease (PAD) and who are taking HRT is controversial. Aim To summarise what is known about HRT and its effect on the natural progression of PAD and its subsequent treatment. Methods A MEDLINE (1966–2004) and Cochrane library search for articles relating to HRT and PAD was undertaken. Results The potential benefits of unopposed estrogen therapy on atherosclerotic progression and limb microcirculation are outweighed by the increased risk of endometrial dysplasia and thrombotic complications. Only one major study (Rotterdam) specifically assessed the impact of HRT on the clinical course of PAD. The findings suggested a decreased risk of PAD among healthy post-menopausal women taking HRT which contrasts with the sub-group analyses of other major studies (HERS/HERS II). HRT appears to reduce the primary success rates of both endovascular and open surgical revascularisation in patients with PAD. Conclusions Further studies are required to investigate the effects of HRT on the progression of PAD and its management.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2007.06.002