Point of View Hormonal Replacement and Cardiovascular Disease: a Guideline against the Evidence

Cardiovascular diseases / prevention and control; climacteric; menopause; hormone replacement therapy. The I Brazilian Guideline for the Prevention of Cardiovascular Diseases in Climacteric Women was recently published in the Archives1. The initiative is welcome, but it is evident that, even though it is a joint guideline of the Brazilian Society of Cardiology (SBC) and of the Brazilian Society of Climacterium, there is a predominance of colleagues specialized in climacterium among its authors. Only six out 40 participants are cardiologists and practically all of the others are members of the Brazilian Association of Climacterium. Undoubtedly, colleagues that take care of climacteric patients do have expertise in their whole care, but cardiologists surely understand about the prevention of cardiovascular diseases. The lack of isonomy among the specialists who wrote the guideline is inverted at the time of the publication. For now, the publication has been restricted to the Archives, a Brazilian leading journal with high visibility. I am unaware of the existence of a journal of the associated specialty and there is no mention of this guideline on the page of the Brazilian Society of Climacterium. I am also unaware of the current rules for guidelines of the SBC, which should include recommendations for carrying out guidelines together with other societies. The formal aspects regarding the publication of this guideline, however, are not the aim of this comment, which intends to challenge, based on the best available evidence, the recommendation for using hormonal replacement therapy (HRT) to prevent cardiovascular disease (CVD) in climacteric women.