Hormone Replacement Therapy and Cardiovascular Risk in Postmenopausal Women

Primary Cardiovascular Risks

Combined estrogen-progestin therapy increases coronary heart disease events by 29% (RH 1.29; 95% CI 1.02-1.63) in postmenopausal women, with risk evident shortly after starting therapy 2
The risk of coronary heart disease is highest in the first year of therapy, with a 52% increase in cardiovascular events (42.5 versus 28.0 per 1000 person-years) compared to placebo 4
Combined HRT increases stroke risk by 41% (RH 1.41; 95% CI 0.86-2.31) in postmenopausal women 2
Venous thromboembolism risk increases 2-fold (RH 2.11; 95% CI 1.26-3.55) with combined estrogen-progestin therapy in postmenopausal women 2

The American Heart Association recommends that combined estrogen-progestin therapy should not be initiated to prevent cardiovascular disease in postmenopausal women (Class III, Level A) 1
The American College of Cardiology recommends that combined estrogen-progestin therapy should not be continued to prevent cardiovascular disease in postmenopausal women (Class III, Level C) 1
Current hormone users have a 25% greater likelihood of having hypertension compared to non-users 6
Women in their late 60s represent a particularly high-risk population for HRT-related cardiovascular events 4

The American Heart Association recommends that HRT should not be initiated for secondary prevention of cardiovascular disease in postmenopausal women 8
In women with established atherosclerosis, there is no overall cardiovascular benefit and possible early increased risk with HRT 4