Drug with high cardiotoxicity (6/15)
6. Hormone Replacement Therapies (HRT)
?? Hormones like estrogen and testosterone can have cardiovascular effects:
- Estrogen replacement therapy in postmenopausal women has been linked to an increased risk of venous thromboembolism (blood clots), stroke, and heart attack.
? Estrogen Replacement Therapy (ERT):
Estrogen therapy is used primarily to manage menopausal symptoms such as hot flashes, bone density loss, and vaginal atrophy. It helps maintain cardiovascular health by improving lipid profiles, enhancing endothelial function, and reducing vascular inflammation.
Venous Thromboembolism (VTE): Estrogen increases the risk of blood clot formation, particularly in the deep veins (deep vein thrombosis, DVT) and pulmonary arteries (pulmonary embolism). This is especially true for oral formulations.
Stroke and Myocardial Infarction (Heart Attack): In some studies, estrogen has been linked to an increased risk of stroke, especially in older women or those who start HRT late in menopause. The Women’s Health Initiative (WHI) study found an increased risk of heart attack in women over 60 starting HRT, though younger women may experience protective effects.
Breast Cancer: Though not directly a cardiovascular risk, increased cancer risk leads to more aggressive cancer treatments, which can secondarily affect the cardiovascular system.
Routine cardiovascular risk assessment, including blood pressure, cholesterol levels, and clotting risk (D-dimer tests). Estrogen therapy is typically used at the lowest effective dose for the shortest possible duration to minimize risks.
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- Testosterone replacement therapy can increase the risk of blood clots, hypertension, and may accelerate atherosclerosis (plaque buildup in arteries).
? Testosterone Replacement Therapy (TRT):
Testosterone replacement is used to treat hypogonadism in men, improving symptoms like low libido, fatigue, and muscle loss. It can improve metabolic profiles by increasing muscle mass and reducing fat mass.
Increased Risk of Cardiovascular Events: Some studies have shown that TRT increases the risk of heart attack, stroke, and venous thromboembolism, particularly in older men or those with pre-existing cardiovascular conditions. However, this is a matter of ongoing debate, with some studies showing neutral or even beneficial effects.
Hypertension: Testosterone may increase red blood cell count (polycythemia), which can lead to increased blood viscosity and higher blood pressure, heightening cardiovascular risk.
Atherosclerosis Acceleration: Although TRT can improve lipid profiles, there is some evidence that it may accelerate atherosclerosis, particularly in men with pre-existing coronary artery disease.
Regular blood tests to monitor hematocrit, cholesterol levels, and blood pressure. Periodic cardiovascular evaluations should be conducted, especially in older men or those with cardiovascular risk factors.
Ensuring cardiac safety is essential to increasing the
success rate of new drug development.
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