Hormone Replacement Therapy, Prothrombotic Mutations, and the Risk of Incident Nonfatal Myocardial Infarction in Postmenopausal Women

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Abstract
For many years, recommendations about the use of hormone replacement therapy (HRT) in postmenopausal women have been based largely on observational studies, which suggest that HRT reduces the risk of coronary heart disease.1-3 The likely mechanisms are numerous4 and include the beneficial effects of estrogens on lipids.5 But estrogens are also known to be prothrombotic.6 In men with prostate cancer or cardiovascular disease7,8 and in women on oral contraceptives,9 high doses or potent formulations of estrogens are associated with thrombotic complications, including myocardial infarction (MI), stroke, and venous thrombosis. In postmenopausal women, HRT is also a risk factor for venous thrombosis.10-13