The effect of estrogen replacement in primary and secondary prevention of cardiovascular disease has strong observational and epidemiologic support. These early adverse effects may reflect more a procoagulation effect of estrogen than a lack of beneficial effect on lipids. Because cardiovascular events actually decreased in the estrogen group after the initial period, a partial salutary effect of estrogen might still be construed. Other studies using estrogen and estrogen-progestin therapies are ongoing, with results expected in the next five to six years. Until recently, clinical drug trials for primary prevention of cardiovascular disease had not included enough women for treatment conclusions to be made.
Differences remain in many important issues related to cardiovascular disease.
The influence of concurrent conditions and lifestyle features, especially diabetes, smoking, systolic hypertension and exercise appears to be stronger in women. It appears that the prevention, diagnosis and treatment of cardiovascular disease may never be completely gender blind. Bruce E. Johnson, M.D., is professor of medicine at the University of Iowa College of Medicine, Iowa City. Cynda Ann Johnson, M.D., M.B.A., is professor of family medicine at the University of Iowa College of Medicine. The evaluation of chest pain in women.