HRT and heart disease
Last edited 10/2020 and last reviewed 09/2021
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. Also explain that the baseline population risk of stroke in women aged under 60 years is very low
- Table 1: Absolute rates of coronary heart disease for different types
of HRT compared with no HRT (or placebo), different durations of HRT use and
time since stopping HRT for menopausal women
- table shows the difference in coronary heart disease incidence per 1000
menopausal women over 7.5 years (95% confifidence interval) (baseline
population risk in the UK over 7.5 years: 26.3 per 1000)
- table shows the difference in coronary heart disease incidence per 1000
menopausal women over 7.5 years (95% confifidence interval) (baseline
population risk in the UK over 7.5 years: 26.3 per 1000)
-
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 repect 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
- BMS, IMS, EMAS, RCOG and AMS Joint Statement on menopausal hormone therapy (MHT) and breast cancer risk in response to EMA Pharmacovigilance Risk Assessment Committee recommendations in May 2020
- Boardman HM, Hartley L, Eisinga A, et al. Hormone therapy for preventing cardiovascular disease in postmenopausal women. Cochrane Database Syst Rev 2015;3:CD002229
cardiovascular (CV) risk if stopped HRT
menopause and cardiovascular (CV) disease risk