Four out of every ten female deaths in Canada each year are due to heart disease and stroke. Until recently, the role of HRT for primary prevention of both cardio and cerebrovascular disease was not clear, with variable levels of evidence available. Prior to July 2002, seventeen studies meeting inclusion criteria were published, one small RCT and 16 prospective cohort studies. Most showed a protective association with estrogen, alone or in combination with a progestin, on myocardial infarction or death from cardiovascular disease in peri-menopausal women without established CAD. This is in contrast to the recent Womens Health Initiative trial, which showed evidence of potential harm. There is no beneficial effect from HRT on rates of stroke or stroke related death in the available studies. HRT for the sole purpose of prevention of cardiac disease is therefore not indicated.
There is fair evidence to recommend against the use of HRT for the primary prevention of myocardial infarction and death from cardiovascular disease in peri-menopausal women without established CAD (D recommendation). To maintain good heart health, women should be advised to adopt other effective preventive strategies, such as lifestyle changes that include increased exercise, lower fat diets, smoking cessation, and blood pressure assessment and control. There is insufficient evidence to make a recommendation on the use of HRT for the primary prevention of stroke and death from cerebrovascular disease.