[Hormone replacement therapy and prevention of postmenopausal cardiovascular diseases].
Hormone replacement therapy (HRT) prevents and delays the development of cardiovascular diseases affecting postmenopausal women, particularly coronary insufficiency. This favourable action has a multifactorial mechanism and concerns: the heart, as HRT improves diastolic filling; the arteries, especially the coronary arteries, which HRT dilates by increasing NO production and possibly via its antioxidant properties; carbohydrate and lipid metabolism, which are modified in a direction unfavourable to atheroma; haemostasis, because it decreases the risk of thrombosis and increases endogenous fibrinolysis. These properties are essentially due to oestrogens, but they persist with the addition of progestogens. They encourage the prescription of HRT for as long as possible, although the recommended duration currently remains unclear. With time, however, the slightly increased breast cancer risk demands at least annual review of treated women.