Estrogen for women at varying risk of coronary disease

Many epidemiological studies show that women who use estrogen therapy after menopause have significantly lower rates of heart disease than postmenopausal women who do not take estrogen. However, few studies have assessed the impact of estrogen use among women with a distinctly higher cardiovascular risk. Seven studies of estrogen therapy in women with established coronary heart disease (such as, coronary stenosis and prior myocardial infarction) are briefly reviewed. These studies all find fewer recurrent cardiovascular events and an improved survival in the estrogen group when compared to the non-estrogen group. Analyses of the effect of estrogen within different risk factor categories in the 16-year follow up of the Nurses' Health Study confirms that although relevant risk estimates are highly similar, the magnitude of the protective effect of estrogen is more pronounced among women with high baseline risk of disease. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.