Prevention & lipidsCohort study
Menopausal Hormone Therapy and Cardiovascular Risk in Midlife Women With Vasomotor Symptoms
- Cohort data used to emulate a sequence of target trials
- multiethnic
- multicenter
- longitudinal
Authors' conclusion
The presented results are pooled from all target trials and found that MHT initiation during perimenopause or recently postmenopausal women with vasomotor symptoms was estimated to reduce CVD risk by 22%. Benefits were more pronounced in Black women and women who initiated MHT within 10 years of menopause onset. However, all estimates warrant caution given the potential for residual confounding. Given the inconsistency of the cardiovascular benefits and the need to consider overall risk-benefit balance, these findings should not be used to support MHT for CVD prevention.
Study context
- Population
- Perimenopausal and recently postmenopausal women with self-reported vasomotor symptoms, CVD-free, with no prior menopausal hormone therapy (MHT) use (SWAN, 1997–2017)women who reported any vasomotor symptoms, 755 initiated MHT
- Participants
- 2,737 participants
- Exposure
- MHT initiation vs noninitiation
- MHT initiationn = 755
Main finding
Fatal and nonfatal CVD events · 20-year follow-up period
Adjusted hazard ratio
0.78
95% CI 0.62–0.98
As reported in the abstract
- fatal and nonfatal CVD events occurred
- 224
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| CVD events by timing of MHT initiation from onset of menopause · initiating MHT 10 or fewer years from onset of menopause | 0.73 (0.58–0.93) | |
| CVD events by timing of MHT initiation from onset of menopause · initiating MHT more than 10 years from onset of menopause | 1.53 (0.66–3.52) | |
| CVD events by race and ethnicity · Black women | 0.51 (0.33–0.81) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
| Outcome | MHT initiation | noninitiation | Estimate |
|---|---|---|---|
| Age of MHT initiators | mean 53.7 (SD 4.6) years | Not reported in the abstract |
- CVD events by timing of MHT initiation from onset of menopause: P value for interaction: .02
- CVD events by race and ethnicity: P value for interaction = .007
CVD events by race and ethnicity
- No clear effects observed in White women or women of other races
Original publication
Summarised from the published abstract; every number is checked against it