Prof John Stevenson1
1National Heart & Lung Institute, Imperial College London, Royal Brompton Hospital, London, United Kingdom
Biography:
Prof John C Stevenson MB BS, FRCP, FRCOG, FESC, MFSEM is Emeritus Reader in Metabolic Medicine in the National Heart and Lung Institute, Imperial College London, Visiting Professor at the Belgrade School of Medicine, and honorary Consultant Physician at the Royal Brompton Hospital, London, where he jointly ran the UK’s first female heart disease clinic. He graduated from King’s College Hospital, London. His research has included studies of metabolic risk factors for coronary heart disease and the effects of sex hormone deficiency and replacement, and the diagnosis, prevention and treatment of osteoporosis. He has over 460 publications in journals and books, including 12 textbooks. He is Chairman of the charity Women’s Health Concern, Trustee of the British Menopause Society, and Executive Committee Member of the International Society of Gynecological Endocrinology. He was made Fellow Honoris Causa of the RCOG in 2022 for his contribution to women’s healthcare.
Abstract:
Modification of risk factors for cardiovascular disease will help prevent the development of disease. This will include addressing lifestyle factors such as smoking cessation, physical exercise and weight reduction where necessary. Therapeutic interventions may be needed for disorders such as diabetes mellitus, hypertension and lipid abnormalities. Menopause is a major risk factor for coronary heart disease (CHD). Loss of oestrogen at the menopause results in adverse metabolic and vascular changes, with increases in LDL cholesterol and triglycerides, decreases in HDL cholesterol, increases in central fat distribution, decreases in pancreatic insulin secretion, and a steady increase in insulin resistance following the menopause. There are increases in arterial stiffness and a deterioration in vascular function. These changes lead to a doubling of risk for CHD. Hormone replacement therapy (HRT) may be used to improve vascular function, reduce atheroma development and correct metabolic abnormalities. The biological plausibility for these cardiovascular benefits of HRT is overwhelming. Appropriate selection of hormones, doses and routes of administration need to be considered. If the oestrogen needs to be opposed, non-androgenic progestogens are the preferred choice because of their metabolic and haemostatic neutrality.