Heart disease and HRT
NICE state with respect to HRT and cardiovascular disease (1):
- HRT:
- does not increase cardiovascular disease risk when started in women aged under 60 years
- does not affect the risk of dying from cardiovascular disease
- the presence of cardiovascular risk factors is not a contraindication to HRT as long as they are optimally managed
- the baseline risk of coronary heart disease and stroke for women around menopausal age varies from one woman to another according to the presence of cardiovascular risk factors
- HRT with oestrogen alone is associated with no, or reduced, risk of coronary heart disease
- HRT with oestrogen and progestogen is associated with little or no increase in the risk of coronary heart disease.
Data shows taking oral (but not transdermal) oestrogen is associated with a small increase in the risk of stroke.
Current HRT users | Treatment duration <5 years | Treatment duration 5-10 years | >5 years since stopping treatment | ||
Women on oestrogen alone | RCT estimate | 6 fewer (-10 to 1) | No available data | No available data | 6 fewer (-9 to -2) |
Women on oestrogen alone | Observational estimate | 6 fewer (-9 to -3) | No available data | No available data | No available data |
Women on oestrogen + progestogen | RCT estimate | 5 more (-3 to 18) | No available data | No available data | 4 more (-1 to 11) |
Women on oestrogen + progestogen | Observational estimate | No available data | No available data | No available data | No available data |
A joint societies statement has noted with respect to HRT and cardiovascular disease (2):
Key points summary |
- The timing MHT (menopausal hormone therapy) is initiated, referred to as the ‘timing hypothesis’ and ‘the cardiovascular window of opportunity’, can have a significant impact on the risk of CVD with MHT intake - Cochrane data-analysis shows that MHT initiated within 10 years of the menopause is likely to be associated with a reduction in coronary heart disease and cardiovascular mortality. - Evidence from the Cochrane data-analysis and that from the long-term follow-up data of the WHI showed no increase in cardiovascular events, cardiovascular mortality or all-cause mortality in women who initiated MHT more than 10 years after the menopause |
Reference:
- NICE (November 2015). Menopause: diagnosis and management
- Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in postmenopausal women. Cochrane Database Syst Rev 2015;3:CD002229
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