Sure hormone alternative remedy (HRT) tablets containing each estrogen and progestogen are related to the next threat of coronary heart illness and uncommon however severe blood clots referred to as venous thromboembolism (VTE) in ladies across the age of menopause, finds a research from Sweden printed by The BMJ at this time.
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 varied results of various hormone mixtures 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 completely 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 handle this, researchers got down to assess the impact of up to date menopausal hormone remedy on the chance of heart problems in keeping with the route of administration and mixture of hormones.
Their findings are based mostly on knowledge from 138 emulated trials (observational research that mimic medical 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 had been assigned to one in every 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 information had been then used to trace cardiovascular occasions over two years, and different doubtlessly influential elements akin to age, training degree, area of residence, hypertension and diabetes had been taken into consideration.
Throughout this monitoring interval, 24,089 cardiovascular occasions had been recorded among the many 919,614 ladies within the research.
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 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 ladies began every of those remedies and had 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 might 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, could have affected their outcomes.
Nonetheless, through the use of an emulated goal trial design they decreased 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 mixtures of hormones.
As such, they are saying: “These findings spotlight the varied results of various hormone mixtures 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 completely 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 based mostly emulated goal trial. BMJ. doi.org/10.1136/bmj-2023-078784.
