Sure hormone substitute remedy (HRT) tablets containing each estrogen and progestogen are related to a better threat of coronary heart illness and uncommon however critical blood clots referred to as venous thromboembolism (VTE) in ladies across the age of menopause, finds a examine from Sweden revealed by The BMJ right this moment.
One other HRT pill known 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 chance of heart problems,” say the researchers.
HRT is used to alleviate menopausal signs akin to sizzling flushes and night time sweats and totally different remedies can be found relying on signs.
Some earlier trials have instructed a hyperlink between menopausal hormone remedy and an elevated threat of heart problems, however info on dangers linked to several types of remedy throughout menopausal transition age is missing.
To deal with this, researchers got down to assess the impact of up to date menopausal hormone remedy on the chance of heart problems in response to the route of administration and mixture of hormones.
Their findings are based mostly on information from 138 emulated trials (observational research that mimic scientific trials), involving 919,614 wholesome ladies in Sweden aged 50-58 between 2007 and 2020 who had not used hormone remedy within the earlier two years. They excluded ladies 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 information, the ladies have been assigned to considered one of eight menopausal hormone remedy 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 information have been then used to trace cardiovascular occasions over two years, and different probably influential elements akin to age, schooling stage, 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 ladies 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 ladies who begin remedy with oral mixed steady remedy or tibolone over one 12 months.
No elevated threat of heart problems was discovered for transdermal remedies, which embody 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 ladies 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 may be drawn about causality, and the authors level to limitations together with an absence of information on menopausal standing and the chance that different unmeasured elements, akin to smoking and physique mass index, might have affected their outcomes.
Nevertheless, through the use of an emulated goal trial design they decreased the bias frequent to observational research and use of registry information allowed them to differentiate between several types 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 chance of heart problems.”
Future analysis ought to examine the potential numerous results on the chance of heart problems based mostly on totally different progestogens utilized in menopausal hormone remedy, they add.
Supply:
Journal reference:
Johansson, T., et al. (2024) Up to date menopausal hormone remedy and threat of heart problems: Swedish nationwide register based mostly emulated goal trial. BMJ. doi.org/10.1136/bmj-2023-078784.
