Cardiovascular risk in menopausal women and prevalent related co-morbid conditions: facing the post-Women's Health Initiative era

Objective: To review scientific publications regarding cardiovascular risk during the menopausal years and that related to currently recognized highly prevalent co-morbid factors within this period. Methods: Citations were selected from a PubMed search and the authors' files according to their clinical and experimental relevance. Results and Discussion: Although experimental and some observational data have supported the fact that estrogens are beneficial for the female vascular system, these positive actions have been challenged by the results of the Women's Health Initiative trial and the Million Women Study, which demonstrated an increase in cardiovascular risk and related adverse events. The role of hormone therapy for the menopause has shifted from a preventive use to a limited role in symptom management, for which it remains the most effective intervention. Baseline evaluation of menopausal women should include individual cardiovascular risk assessment, including hypertension, dyslipidemia, elevated body weight, and the metabolic syndrome. Concomitantly, new factors influencing cardiovascular risk have been delineated among postmenopausal women, namely sleeping disorders, depression, vitamin D insufficiency, rheumatoid arthritis, sexual dysfunction, stress, and psychosocial factors. Therefore, a new landscape may be recognized for menopausal women management. Precise evaluation and treatment of each factor should be separately assessed to improve quality of life and reduce cardiovascular disease prevalence. At present, cardiovascular risk reduction strategies are a requisite (albeit underused) for menopausal women. These include education in terms of health, healthy lifestyle, and pharmacologic preventive interventions to reduce co-morbid conditions. (Fertil Steril (R) 2009;92:1171-86. (C) 2009 by American Society for Reproductive Medicine.)