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Ischaemic heart disease and HRT

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:

  1. NICE (November 2015). Menopause: diagnosis and management
  2. 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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