Impact of menopausal hormone therapy on heart disease depends on timing of initiation

The potential health effects of hormone therapy (HT) have been intensely debated for more than a decade, especially when it comes to coronary heart disease. A new study coming out of Sweden now suggests that the effects differ based on when women started taking HT. The study will be presented at the 2015 Annual Meeting of The North American Menopause Society (NAMS) on September 30.

"We realized that, for all of the studies completed, few had taken into consideration the timing of HT initiation in relation to the onset of menopause," says Dr. Germán Carrasquilla of the Karolinska Institute in Stockholm who served as the lead author of the study. "What we found is that there is a difference with regard to the onset of coronary heart disease depending on when a woman starting taking hormones and when she started menopause."

The authors collected data from five population-based Swedish cohort studies involving a total of 74,352 participants. Percentile differences were estimated in the number of event-free years between the exposed group and the unexposed group. Adjustments were made for age of the participant, age at menopause onset, educational level, body mass index, smoking status, type of menopause, diabetes, hypertension and dyslipidemia.

In the end, it was determined that an early initiation of HT (within five years from menopause onset) was associated with a decreased risk of future incident coronary heart disease, while late initiation was associated with an increased risk.

"With all the conflicting data, studies like this are valuable in helping clinicians and their patients sort out the real impact of hormones and determine who are the best candidates for this therapy," says Dr. Wulf Utian, NAMS executive director.