• Cardiovascular disease. In: Menopause and osteoporosis update 2009. J Obstet Gynaecol Can 2009 Jan;31(1 Suppl 1):S11-8. [71 references]

This is the current release of the guideline.

This guideline updates a previous version: Turek M, Blake J. Cardiovascular disease. In: Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006 Feb;28(2 Suppl 1):S81-5. [54 references]

The rating scheme is defined at the end of the "Major Recommendations" field.

1. Health care providers should not initiate or continue hormone therapy (HT) for the sole purpose of preventing cardiovascular disease (CVD) (coronary artery disease [CAD] and stroke). (IA)
2. Health care providers should abstain from prescribing HT in women at high risk for venous thromboembolic disease (IA)
3. Health care providers should initiate other evidence-based therapies and interventions to effectively reduce the risk of CVD events in women with or without vascular disease. (IA)
4. Risk factors for stroke (obesity, hypertension, and cigarette smoking) should be addressed in all postmenopausal women. (IA)
5. If prescribing HT to older postmenopausal women, health care providers should address cardiovascular risk factors; low- or ultralow-dose estrogen therapy is preferred. (IB)
6. Health care providers may prescribe HT to diabetic women for the relief of menopausal symptoms. (IA)

Definitions:

Quality of Evidence Assessment*

I: Evidence obtained from at least one properly randomized controlled trial.

II-1: Evidence from well-designed controlled trials without randomization.

II-2: Evidence from well-designed cohort (prospective or retrospective) or case-control studies, preferably from more than one centre or research group.

II-3: Evidence from comparisons between times or places with or without the intervention. Dramatic results from uncontrolled experiments (such as the results of treatment with penicillin in the 1940s) could also be included in this category.

III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

Classification of Recommendations**

A. There is good evidence to recommend the clinical preventive action

B. There is fair evidence to recommend the clinical preventive action

C. The existing evidence is conflicting and does not allow to make a recommendation for or against use of the clinical preventive action; however, other factors may influence decision-making

D. There is fair evidence to recommend against the clinical preventive action

E. There is good evidence to recommend against the clinical preventive action

L. There is insufficient evidence (in quantity or quality) to make a recommendation; however, other factors may influence decision-making

*The quality of evidence reported in these guidelines has been adapted from the Evaluation of Evidence criteria described in the Canadian Task Force on Preventive Health Care.***

**Recommendations included in these guidelines have been adapted from the Classification of Recommendations criteria described in the Canadian Task Force on Preventive Health Care.***

***Woolf SH, Battista RN, Angerson GM, Logan AG, Eel W. Canadian Task Force on Preventive Health Care. New grades for recommendations from the Canadian Task Force on Preventive Health Care. Can Med Assoc J 2003;169(3):207-8.

None provided

The type of supporting evidence is identified and graded for each recommendation (see "Major Recommendations").

• Cardiovascular disease. In: Menopause and osteoporosis update 2009. J Obstet Gynaecol Can 2009 Jan;31(1 Suppl 1):S11-8. [71 references]

Not applicable: The guideline was not adapted from another source.

2006 Feb (revised 2009 Jan)

Society of Obstetricians and Gynaecologists of Canada - Medical Specialty Society

Society of Obstetricians and Gynaecologists of Canada

Not stated

Principal Authors: Robert L. Reid, MD, FRCSC, Kingston ON; Jennifer Blake, MD, FRCSC, Toronto ON; Beth Abramson, MD, FRCPC, Toronto ON; Aliya Khan, MD, FRCPC, Hamilton ON; Vyta Senikas, MD, FRCSC, Ottawa ON; Michel Fortier, MD, FRCSC, Quebec QC

The following conflicts of interest have been disclosed by the authors.

Dr Reid: Speaker or consultant to Wyeth, Bayer, Organon, Proctor and Gamble, Novo Nordisk; advisory boards: Paladin, Wyeth; research support: Organon, Bayer.

Dr Blake: Speaker or consultant to Wyeth, Merck, Glaxo Smith Kline, Bayer; advisory boards: Bayer, Wyeth and Lilly, Novo Nordisk.

Dr Abramson: Speaker or consultant to Abbott, Astra Zeneca, Boehringer Ingelheim, Bristol Myer Squibb, Dupont, Eli Lilly, Lifespeak, Norvartis, Fournier, Merck Frosst, Pfizer, Servier, Schering, Sanofi-Aventis; advisory boards: Astra Zeneca, Boehringer-Ingelheim, Novartis, Pfizer, Sanofi-Aventis; research support: Astra Zeneca, Boehringer Ingelheim, Merck.

Dr Khan: Speaker or consultant to Amgen, Merck, Lilly, Novartis, Servier, Proctor and Gamble; research support: Merck, Lilly, Novartis, Alliance for Better Bone Health.

Dr Senikas: None declared.

Dr Fortier: Speaker or consultant to Proctor and Gamble, Merck; advisory boards: Amgen, Bayer, Novo Nordisk, Novartis, GlaxoSmith Kline, Lilly, Paladin; research support: Wyeth, Sanofi.

This is the current release of the guideline.

This guideline updates a previous version: Turek M, Blake J. Cardiovascular disease. In: Canadian consensus conference on menopause, 2006 update. J Obstet Gynaecol Can 2006 Feb;28(2 Suppl 1):S81-5. [54 references]

None available

None available

This NGC summary was completed by ECRI Institute on April 30, 2009. The information was verified by the guideline developer on May 21, 2009.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.