What effect does estrogen have on the heart?

Anthony L. Komaroff, MD
Internal Medicine
Estrogen raises protective high-density lipoprotein (HDL) cholesterol and lowers harmful low-density lipoprotein (LDL) cholesterol. But when estrogen declines at menopause, typically around age 50, so do its protective effects, causing an increase in the risk for heart disease. Women who have gone through menopause are two to three times more likely to develop heart disease than women the same age who are still menstruating. Yet, as two major studies have shown, hormone replacement therapy does not prevent heart disease and may actually increase heart disease risk in some women.

Even a decade ago, estrogen was thought to have a protective effect on the heart in menopausal and postmenopausal women and to reduce heart disease. This made sense, as women’s risk for heart disease increases when their estrogen levels decrease and menopause begins. However, the conventional wisdom that supplementing estrogen in postmenopausal women would reduce heart disease was proven false by a growing body of research, including the data from a large study called the Women’s Health Initiative. Estrogen administered as hormone replacement therapy was shown to have no effect on heart health but to increase stroke risk. Combination therapies including both the hormones estrogen and progesterone were shown to actually raise the risk of heart attack and stroke and also of breast cancer.

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