Previous research shows that women are generally at a higher risk for cardiovascular disease after reaching menopause.
This increased heart disease risk is due to several different factors, including lower levels of the hormone estrogen, stiffening of blood vessels, and changes in cholesterol and general metabolism.
Past studies have found that taking hormone replacement therapy (HRT), also known as menopausal hormone therapy (MHT), may help lower a woman’s heart disease risk during and after menopause.
Now, a new study published in the journal JAMA Internal Medicine adds to what we know about the link between hormone therapy and heart disease risk.
Researchers report that women who start hormone therapy during perimenopause or early postmenopause may decrease their cardiovascular disease risk by 22%, compared to those not taking hormone therapy.
For this study, researchers analyzed 20 years of health data for more than 2,700 women who were part of the SWAN (Study of Women’s Health Across the Nation) project.
Female participants selected for this study self-reported menopause-related vasomotor symptoms, such as hot flashes and night sweats, and had no prior heart disease diagnosis. They also self-reported whether or not they were on hormone therapy.
“Vasomotor symptoms, such as hot flashes and night sweats, are common during the menopause transition and have been associated with future cardiovascular risk,” Samar R. El Khoudary, PhD, MPH, BPharm, FAHA, professor and chair of the Department of Epidemiology, and director of Women’s Public Health Research Initiatives at the School of Public Health at Virginia Commonwealth University, and co-senior author of this study, told Medical News Today.
“At the same time, much of the previous research on MHT and cardiovascular disease has focused on women who were already postmenopausal, leaving less evidence about women during perimenopause and early postmenopause, when hormonal changes and symptoms are particularly prominent,” El Khoudary added.
“We saw an opportunity to use the long-term SWAN data to examine this question specifically among women with vasomotor symptoms and to explore whether the timing of hormone therapy initiation matters,” she told us.
At the study’s conclusion, researchers found that women who started hormone therapy during perimenopause or early postmenopause experienced a cardiovascular disease risk reduction of 22%, compared to those not taking hormone therapy.
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Scientists also discovered the protective effect of hormone therapy was strongest in women who started it within 10 years of menopause onset for a 27% lower heart disease risk.
Researchers also noted the hormone therapy protective benefit was highest among Black women, lowering their cardiovascular disease risk by 49%.
“These findings suggest that the estimated association between menopause hormone therapy and cardiovascular disease may differ depending on when treatment is initiated and across different racial and ethnic groups. The stronger estimated effect among women who initiated therapy within 10 years of menopause onset is consistent with the possibility that there may be a window during the menopause transition and early postmenopause when the cardiovascular effects of hormone therapy are different.”
– Samar R. El Khoudary, PhD, MPH, BPharm, FAHA
“Because this was an observational study, residual confounding or other differences between groups could also contribute to the findings,” El Khoudary continued. “These results therefore need to be interpreted with caution and to be confirmed in future clinical trials.”
MNT had the opportunity to speak with Jennifer Wong, MD, a board-certified cardiologist and medical director of Non-Invasive Cardiology at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA, about this study.
Wong, who was not involved in the research, commented that these findings are encouraging and add to the growing evidence that the timing of hormone therapy may matter.
“The study suggests that starting hormone therapy earlier in the menopausal transition may have cardiovascular benefits for certain women, although more research is needed to determine which patients are most likely to benefit,” Wong explained.
“The hormonal changes of perimenopause and menopause can coincide with changes in several cardiovascular risk factors,” she added.
“Frequent or severe vasomotor symptoms, such as hot flashes and night sweats, have been associated with a higher risk of future cardiovascular events and may also occur alongside an unfavorable metabolic profile, including higher blood pressure, abnormal cholesterol levels, and elevated fasting glucose [blood sugar],” she continued.
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“Menopause itself is not a disease, but this stage of life can be an important time to pay closer attention to cardiovascular health and risk factors,” Wong pointed out.
She said that women should not feel that they simply have to endure significant hot flashes or night sweats:
“These symptoms can substantially affect quality of life and may also be a marker of increased cardiovascular risk. Women experiencing frequent or severe vasomotor symptoms should talk with their healthcare professional about treatment options and their individual cardiovascular risk. Hormone therapy may be appropriate for some women but is not recommended for everyone, so the decision should be individualized.”
MNTalso spoke with Prudence Hall, MD, an OB/GYN in private practice in Santa Monica, CA, who likewise was not involved in this study.
Hall commented she was happy to see further studies on HRT and especially this study including perimenopausal women, which frequently starts in our mid 30s to early 40s.
“The reported decrease it has on cardiovascular disease has been in our literature for some time and this is a good confirmation and addition,” she added.
When asked how hormone therapy might help lower heart disease risk, Hall said one of the reasons is that a type of estrogen called estradiol helps lower blood sugar and stress.
“It is also anti-inflammatory and lowers the LDL cholesterol, as well as the bad APOB and Lp(a) LDL subparticles, which increase plaque, which is responsible for heart disease,” she explained.
“These root core causes of chronic diseases like heart disease, high blood pressure, and stroke all decrease, as well as Alzheimer’s disease, diabetes, many cancers, and all cause mortality. Unhealthy aging is greatly decreased, which is why I remain so very positive about treating menopause with bioidentical hormones and encouraging lifestyle interventions.”
– Prudence Hall, MD
“Keep in mind that once a woman enters menopause, if left untreated, she remains in menopause for the rest of her life,” Hall added. “Therefore, the way we handle our menopause will determine the outcome of the next 40-50 years to create a life of radiant vitality or a life of continual decline.”
