The most important cardiovascular risks are myocardial infarction, stroke, and venous thromboembolism – also end points in the Women’s Health Initiative (WHI), which studied HRT in women aged on average about 65 years at high cardiovascular risk. Taking all evidence into account, an increase in risk for venous thrombosis has been confirmed at least for oral HRT. Based on the WHI increased stroke risk should be regarded as proven, but probably only for predisposed or elderly women, especially hypertensive patients. Concerning myocardial infarction the risk is more likely to be reduced in younger women without preexisting cardiovascular conditions, especially during estrogen-only therapy. However, according to current data HRT is not recommended for primary prevention, although in the WHI trial the risk of myocardial infarction was only significantly increased in women starting HRT 20 years after menopause. However, a risk increase should also be considered in younger women at enhanced risk, especially with preexisting cardiovascular conditions.