Due to the decrease of estrogen in postmenopausal women, heart disease is the leading cause of
death in women sixty-five years of older. A primary focus of women’s health care over the last
decade is the reversal hormone replacement therapy and change in lifestyle can have over this
devastating disease. Hormone replacement therapy has been found, not only to prevent
cardiovascular illness, but also aids in the fight of osteoporosis and epidermal changes. The
ultimate decision of beginning a cycle of hormone replacement therapy must be left up to the
The more risk factors a woman has, the greater the chance of having a heart attack. “The
four major changeable risk factors for heart disease are smoking, high cholesterol, high blood
pressure, and physical inactivity” (McMicheal 1). Women who smoke cigarettes of cigars have
a much higher risk of death from heart disease or stroke. “A woman who smokes runs from two
to six times the risk of having a heart attack and is more likely than a nonsmoker is to die form a
heart attack” (McMicheal 2). Two types of cholesterol affect the threat of heart disease. Low
density lipoprotein (LDL) deposits some cholesterol into artery walls causing the buildup of
plaque which raises the risk of heart disease. High density lipoprotein (HDL) cleans the
cholesterol out of the body’s system and lowers the risk of heart disease. High blood pressure,
many times, is found to be the silent killer behind many heart attack deaths. The heart attack is
caused by a great strain put on the heart and arteries in order to pump blood throughout the
cardiovascular system. High blood pressure and cholesterol levels can be linked to obesity due
to physical inactivity. “Physically inactive women are twice as likely as active women to
develop heart disease” (McMicheal 6).
Statistics show that slightly more than one of every two women in the United States will
die from cardiovascular illness. Since 1984, the number of female deaths due to heart disease

has slowly inched above the number of male deaths according to the American Heart
Association. Although the overall death rate does not differ greatly between genders, experts say
the incidence pattern increases. The disease typically develops ten to fifteen years later in
women, with a women’s risk rising considerably after menopause. Researchers believe that a
distinctive pattern suggests that estrogen, which is produced in women’s bodies at relatively high
levels before menopause, offers protection against heart disease.
Once women enter the stage a menopause, estrogen levels steadily begin to decline,
arteries harden, and cholesterol levels increase. Many options exist for women before
significant chances of developing heart disease occur. “The evidence shows that a young
woman with no inherited risk factors can reverse any risk she’s endangered if she changes her
habits at menopause, says Stephen B. Hulley, a University of California at San Francisco
epidemiologist” (Weinhouse 99).
As women begin to reach the golden years of their lives, the question of effectiveness of
estrogen is evident:
“According to the American Heart Association, only 1.3 in every 100,00 women between
the ages of twenty-five and thirty-four die each year of coronary heart disease. From age
thirty-five to forty-four, that number rises to seven in 100,000. Even spanning the
perimenopausal and menopausal years of forty-five to fifty-four, the fatality rate is only 31.6 in
100,00 which is well under one-tenth of one percent” (Weinhouse 99).
Hormone replacement therapy was developed primarily to treat osteoporosis. However,
recent studies have shown that hormone replacement therapy may influence other organ systems
as well, as it compensates for the decreased circulating estrogen levels. The current studies
suggest that hormone replacement therapy may have positive influences on the cardiovascular
system, osteoporosis, and epidermal changes. Consequently, there is also evidence that hormone
replacement therapy may have negative effects in the risk of developing breast cancer,
endometrial cancer, and gallstone or gallbladder disease.

The most common replacement therapies administered to postmenopausal women are
estrogen replacement therapy and combined hormone replacement therapy. Combined hormone
replacement therapy includes estrogen with progestin. Estrogen used alone can greatly increase
the chances of acquiring uterine cancer. Many doctors insist on prescribing patients drugs that
contain the combined hormone replacement therapy. “This eliminates the extra risk of uterine
cancer, but animal experiments suggested that the combination pills might not do as good a job
as protecting the heart” (Swift 18). In human experimentation, a large study found that the
combination pill therapy proved to be highly effective in protecting against heart disease. “Dr.
Charles H. Hennekens of Brighman and Women’s Hospital in Boston, senior author of the study,
called the