Sure hormone substitute remedy (HRT) tablets containing each estrogen and progestogen are related to the next threat of coronary heart illness and uncommon however severe blood clots often called venous thromboembolism (VTE) in girls across the age of menopause, finds a examine from Sweden printed by The BMJ right now.
One other HRT pill referred to as tibolone was related to an elevated threat of coronary heart illness, coronary heart assault and stroke, however not blood clots, “highlighting the various results of various hormone combos and administration strategies on the danger of heart problems,” say the researchers.
HRT is used to alleviate menopausal signs comparable to sizzling flushes and evening sweats and totally different remedies can be found relying on signs.
Some earlier trials have advised a hyperlink between menopausal hormone remedy and an elevated threat of heart problems, however info on dangers linked to various kinds of remedy throughout menopausal transition age is missing.
To deal with this, researchers got down to assess the impact of latest menopausal hormone remedy on the danger of heart problems in accordance with the route of administration and mixture of hormones.
Their findings are primarily based on knowledge from 138 emulated trials (observational research that mimic scientific trials), involving 919,614 wholesome girls in Sweden aged 50-58 between 2007 and 2020 who had not used hormone remedy within the earlier two years. They excluded girls with a historical past of coronary heart illness, stroke, narrowed arteries, or most cancers, and who had undergone surgical procedure to take away their ovaries, a hysterectomy, or sterilization.
Utilizing month-to-month prescription data, the ladies have been assigned to certainly one of eight menopausal hormone therapy teams: oral mixed steady, oral mixed sequential, oral unopposed estrogen, oral estrogen with native progestin, tibolone, transdermal mixed, transdermal unopposed estrogen, or no menopausal hormone remedy.
Hospital data have been then used to trace cardiovascular occasions over two years, and different doubtlessly influential components comparable to age, schooling degree, area of residence, hypertension and diabetes have been taken under consideration.
Throughout this monitoring interval, 24,089 cardiovascular occasions have been recorded among the many 919,614 girls within the examine.
In contrast with not beginning menopausal hormone remedy, beginning oral mixed steady remedy or tibolone was related to an elevated threat of ischemic coronary heart illness. This interprets to roughly 11 new instances of ischemic coronary heart illness per 1,000 girls who begin therapy with oral mixed steady remedy or tibolone over one 12 months.
No elevated threat of heart problems was discovered for transdermal remedies, which embrace pores and skin patches, gels and lotions.
An elevated threat of blood clots was additionally discovered for oral mixed steady, oral mixed sequential, oral unopposed estrogen, and transdermal mixed remedy. “If 1,000 girls began every of those remedies and have been noticed for a 12 months, we might count on to see seven new instances of venous thromboembolism throughout all teams,” say the authors.
Tibolone was additionally linked to an elevated threat of stroke and coronary heart assault, however not blood clots.
These are observational findings, so no agency conclusions could be drawn about causality, and the authors level to limitations together with an absence of information on menopausal standing and the likelihood that different unmeasured components, comparable to smoking and physique mass index, might have affected their outcomes.
Nevertheless, by utilizing an emulated goal trial design they diminished the bias frequent to observational research and use of registry knowledge allowed them to tell apart between various kinds of hormone therapies, together with variations in administration, regimens, and combos of hormones.
As such, they are saying: “These findings spotlight the various results of various hormone combos and administration strategies on the danger of heart problems.”
Future analysis ought to examine the potential numerous results on the danger of heart problems primarily based on totally different progestogens utilized in menopausal hormone remedy, they add.
Supply:
Journal reference:
Johansson, T., et al. (2024) Modern menopausal hormone remedy and threat of heart problems: Swedish nationwide register primarily based emulated goal trial. BMJ. doi.org/10.1136/bmj-2023-078784.