A number of lines of evidence have suggested that postmenopausal hormone replacement therapy might be useful in the primary and secondary prevention of coronary heart disease (CHD). Data from recent randomized trials are consistent in showing no overall benefit of hormone replacement therapy as a continuous combined regimen of estrogen and a progestin (PERT) in preventing the development of CHD or preventing recurrent events or progression of atherosclerosis. The randomized trials also raise questions about hormone replacement therapy in the form of estrogen alone (ERT) for prevention of CHD and CHD recurrence. Other interventions to prevent CHD and decrease morbidity and mortality in women with established disease have a strong evidence base. Hormone replacement therapy should not be recommended to prevent CHD or CHD recurrence until and unless data from randomized trials establish this as a benefit.