Hormone Replacement Therapy and Cardiovascular Disease

From The Critics

Reviewer: Mindy A. Schwartz, MD(University of Chicago Pritzker School of Medicine)
Description: This is a compilation of the presentations given during the Expert Workshop on Hormone Replacement Therapy and Cardiovascular Disease organized by the International Menopause Society held in London in October 2000 at the Royal Society of Medicine. The book marks the first of a series of Expert Workshops in the area of Climacteric Medicine.
Purpose: The aim is to present a compendium of the clinically relevant issues related to hormone replacement therapy and the leading cause of death in women — cardiovascular disease. The book is clearly that. This important subject is among the most relevant and challenging facing the practicing physician today. It is a complex area that crosses traditional medical specialties.
Audience: The intended audience is all healthcare providers who care for menopausal women. Although many will benefit from such a compendium, practitioners in women's health, family practice, obstetrics and gynecology, and internal medicine will find it most useful. It is written at a level that is both detailed in terms of the basic science yet clearly clinically relevant for the busy practitioner.
Features: The book does a wonderful job of covering the science behind atherogenesis, normal changes of aging, and the actions of sex steroids on this complex phenomenon. Chapters on cardiovascular aging, the role of the endothelium and basic mechanisms of sex steroids at the level of the cell, tissue, and organism are all well done and comprehensive. The first half of the book covers the science of cardiovascular disease and the biology of the sex steroids. The second half covers the cardiovascular effects of the available preparations of hormone replacement therapy. The chapters are comprehensive and cover important areas such as the SERMS (selective estrogen receptor modulators) and newer estrogen/progesterone preparations. The clinical effects, including primary and secondary prevention of coronary heart disease, are covered in one small chapter as is the relationship between hormone replacement therapy and stroke and thromboembolism. The tables and pictures are all in black and white but are useful to emphasize the relevant points. The bright pink cover is a bit overpowering but aids in rapid location on the overcrowded bookshelf. Despite the comprehensive approach of the book and the many levels of detail in this rapidly evolving area, there are a few minor shortcomings. First, the chapter on trends in mortality rates is superficial and inappropriately short. The chapters are not uniform, with much more focus on the research and less a review of clinically relevant studies. Finally, there are no chapters on the contemporary and relevant areas of phytoestrogens.
Assessment: Overall, this book clearly achieves its goals of being a comprehensive and detailed reference on this important area. The bibliographies at the end of each chapter are detailed and include relevant web sites of medical importance. The book will be a tremendous aid for any physician who wants to be able to feel knowledgeable about the risks and benefits of hormone replacement therapy for prevention of heart disease in the time after the HERS and ERA trials. It is a relevant and valuable survey of the current status of research and practice into this important and fascinating area.

4 Stars! from Doody