A systematic review and meta-analysis of effects of menopausal hormone therapy on cardiovascular diseases.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 33244065 · doi:10.1038/s41598-020-77534-9
What was done
A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies was conducted searching PubMed and EMBASE (2000–2019) to evaluate the association between menopausal hormone therapy and cardiovascular disease. Quality assessment used the Jadad scale for RCTs and the Newcastle-Ottawa Scale for observational studies. A total of 26 RCTs and 47 observational studies were analyzed, with subgroup assessments by timing of initiation, underlying disease, regimen type, and administration route.
What was found
Venous thromboembolism risk was increased in both RCTs (summary estimate [SE]: 1.70, 95% CI: 1.33–2.16) and observational studies (SE: 1.32, 95% CI: 1.13–1.54). RCTs demonstrated an increased risk of stroke (SE: 1.14, 95% CI: 1.04–1.25), whereas observational studies reported a decreased risk of myocardial infarction (SE: 0.79, 95% CI: 0.75–0.84). Populations in RCTs were older and had more baseline disease than those in observational studies.
Why it matters
The paper highlights key discrepancies between trial and observational data, emphasizing that baseline cardiovascular risk, age, and timing of initiation alter outcomes of menopausal hormone therapy.
Limits
Total participant count and specific numerical estimates for subgroup analyses were not reported in the abstract. Observational findings remain vulnerable to healthy-user bias and confounding by indication.
Cited by
- supports Hormone replacement therapy provides cardiovascular benefits when started early in the menopausal transition, whereas initiating it later loses the protective cardiovascular effect and increases health risks.