The economics and management of cardiovascular disease in postmenopausal women

Cardiovascular disease (CVD) in the UK is an important public health problem and a significant burden to the National Health Service and Social Services. In 1998 ischaemic heart disease and cerebrovascular disease were the underlying causes of 32.4% of all deaths among women aged 50 years and over in England and Wales (personal communication from the Office for National Statistics). This review discusses the economics of interventions in the management of CVD in postmenopausal women. The evidence of net health effects of hormone replacement therapy (HRT) indicates that, at least in the case of primary interventions, healthcare professionals should consider alternatives to prescribing HRT to healthy postmenopausal women. A targeted programme of multiple interventions covering drug treatment for reducing blood pressure and lowering cholesterol in the high-risk groups combined with health education should play an important role in the prevention of CVD in this population. Given the multi-factorial aspects of the use of HRT, the effectiveness of alternative preventive treatments for other conditions, apart from CVD, such as osteoporosis and climacteric symptoms, should be investigated, preferably in randomised control trials.