Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial
Authors' conclusion
Use of oral oestrogen-progestin therapy was associated with an increased risk of heart disease and venous thromboembolism, whereas the use of tibolone was associated with an increased risk of ischaemic heart disease, cerebral infarction, and myocardial infarction but not venous thromboembolism.
Study context
- Population
- Women aged 50–58, 2007–2020, no hormone therapy use in the previous two years, Swedish population77,512 initiators
- Participants
- 919,614 women
- Exposure
- Initiators of contemporary menopausal hormone therapy vs non-initiators
- Non-initiatorsn = 842,102reference
- Outcome
- VTE, ischaemic heart disease, cerebral infarction, MI, and composite CVD
Methodological details138 nested trials, Swedish national registries
- 138 nested trials
- Swedish national registries
Main finding
As reported in the abstract
Each group vs non-initiatorsHazard ratio (95% CI)
TiboloneCVD; ITT
1.52(1.11–2.08)
Tiboloneischaemic heart disease; ITT
1.46(1.00–2.14)
Oral oestrogen-progestin therapyischaemic heart disease; ITT
1.21(1.00–1.46)
Oral combined continuousVTE; ITT
1.61(1.35–1.92)
Oral combined sequentialVTE; ITT
2.00(1.61–2.49)
Oestrogen-only therapyVTE; ITT
1.57(1.02–2.44)
- Women with an event during follow-up
- 24 089
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Cerebral infarction and MI (per protocol)Tibolone · cerebral infarction · per protocol: continuous users vs never users | 1.97 (1.02–3.78) | |
| Cerebral infarction and MI (per protocol)Tibolone · MI · per protocol: continuous users vs never users | 1.94 (1.01–3.73) | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Contemporary menopausal hormone therapy and risk of cardiovascular disease: Swedish nationwide register based emulated target trial. BMJ. Published 27 November 2024. doi:10.
Summarised from the published abstract; every number is checked against it