Ten questions on hormone replacement therapy and cardiovascular risk

The impact of hormone replacement therapy (HRT) on the cardiovascular (CV) system in menopausal women has been the subject of significant debate for many years. After a phase marked by restrictive use following the outcomes of the first randomized trials in the 2000s, the last decade has witnessed a significant reassessment of the risks and benefits of therapy, especially CV risk. Thanks to new studies conducted in more selected populations and sub-analyses of earlier trials, there is now ample evidence regarding the high safety profile of HRT, and even protection on the CV system, for young women with a low CV risk profile in the early menopausal phase. This evidence has been incorporated into all national and international menopausal guidelines and, recently, also in a consensus document by the European Society of Cardiology. Therefore, the cardiologist assumes a central role in the risk assessment and treatment of modifiable CV risk factors during the menopausal transition, a critical period for women as it is associated with significant changes in the glycometabolic balance. This article summarises current knowledge on the subject and provides practical guidance for the cardiological management of such patients.