To the Editor:
We appreciate the interesting and well-documented Letter to the Editor written by Dr Fleta-Asín. We totally agree, as is reflected in the section entitled "Unanswered questions" of the review article,1 in that future research will still be necessary to determine whether or not hormone therapy, initiated in the early stages of the menopausal transition, confers cardioprotection or reduces cardiovascular risk. In particular, we need to have greater knowledge on the efficacy of different doses, formulations and modes of administration.
We also concur with respect to the idea that we need more data on the possible beneficial effects of estrogens in the prevention and treatment of atherosclerosis in men. However, some previous results from the Coronary Drug Project of the United States have pointed out the development of serious adverse effects associated with treatment with high-dose conjugated equine estrogens in men who had had a myocardial infarction. Thus, we consider that we need to be extremely cautious when assessing the potential beneficial effects on the lipid profile, since they may be counteracted and overcome by adverse effects on inflammatory markers and on the thrombotic mechanisms.