[Menopausal hormone therapy and cardiovascular disease]

Area of Science:

• Cardiovascular Medicine
• Endocrinology
• Women's Health

Background:

• Observational studies suggested cardiovascular benefits of menopausal hormone therapy (MHT).
• Randomized clinical trials (RCTs) have yielded conflicting results regarding MHT's cardiovascular effects.
• Selective estrogen receptor modulators (SERMs) also showed no cardiovascular benefit in trials.

Purpose of the Study:

• To evaluate the efficacy of MHT and SERMs in preventing cardiovascular events in women.
• To determine if earlier initiation or different formulations of MHT could alter cardiovascular outcomes.
• To emphasize the need for established cardiovascular risk reduction strategies in menopausal women.

Main Methods:

• Analysis of data from well-designed randomized clinical trials.
• Inclusion of trials involving healthy women and those with established coronary heart disease.
• Review of trials evaluating MHT and the SERM raloxifene.

Main Results:

• MHT failed to prevent clinical cardiovascular events in RCTs and was associated with harm.
• Raloxifene did not decrease coronary events.
• Participants in trials often had suboptimal control of cardiovascular risk factors at baseline.

Conclusions:

• Current evidence does not support the use of MHT or SERMs for primary or secondary cardiovascular prevention in postmenopausal women.
• Optimal management of cardiovascular risk factors is crucial for menopausal women.
• Further research is needed to explore potential benefits of alternative MHT strategies (e.g., earlier initiation, lower doses, different routes).