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      Menopause-associated risk of cardiovascular disease

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          Abstract

          Cardiovascular disease (CVD) is of major concern in women entering menopause. The changing hormonal milieu predisposes them to increased CVD risk, due to a constellation of risk factors, such as visceral obesity, atherogenic dyslipidemia, dysregulation in glucose homeostasis, non-alcoholic fatty liver disease and arterial hypertension. However, an independent association of menopause per se with increased risk of CVD events has only been proven for early menopause (<45 years). Menopausal hormone therapy (MHT) ameliorates most of the CVD risk factors mentioned above. Transdermal estrogens are the preferable regimen, since they do not increase triglyceride concentrations and they are not associated with increased risk of venous thromboembolic events (VTE). Although administration of MHT should be considered on an individual basis, MHT may reduce CVD morbidity and mortality, if commenced during the early postmenopausal period (<60 years or within ten years since the last menstrual period). In women with premature ovarian insufficiency (POI), MHT should be administered at least until the average age of menopause (50–52 years). MHT is contraindicated in women with a history of VTE and is not currently recommended for the sole purpose of CVD prevention. The risk of breast cancer associated with MHT is generally low and is mainly conferred by the progestogen. Micronized progesterone and dydrogesterone are associated with lower risk compared to other progestogens.

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          Most cited references60

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          2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk

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            2021 ESC Guidelines on cardiovascular disease prevention in clinical practice

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              2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

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                Author and article information

                Journal
                Endocr Connect
                Endocr Connect
                EC
                Endocrine Connections
                Bioscientifica Ltd (Bristol )
                2049-3614
                08 March 2022
                01 April 2022
                : 11
                : 4
                : e210537
                Affiliations
                [1 ]Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology , Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
                [2 ]2nd Department of Obstetrics and Gynecology , National and Kapodistrian University of Athens, Medical School, Athens, Greece
                [3 ]National Heart and Lung Institute , Imperial College London, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
                Author notes
                Correspondence should be addressed to P Anagnostis: anagnostis@ 123456auth.gr
                Author information
                https://orcid.org/http://orcid.org/0000-0002-8949-4312
                Article
                EC-21-0537
                10.1530/EC-21-0537
                9066596
                35258483
                2556c7f4-5140-4a97-908d-53abcfc47a4b
                © The authors

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 28 February 2022
                : 08 March 2022
                Product
                Categories
                Review

                menopausal hormone therapy,early menopause,premature ovarian insufficiency,cardiovascular disease

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