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Menopausal HT not linked to adverse changes in cardiac structure

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March 8, 2018

Postmenopausal women using menopausal hormone therapy for at least 3 years were not at increased risk for adverse, subclinical changes in cardiac structure or function compared with women never prescribed the therapy, study data show.

Steffen E. Petersen, MD, DPHIL, MPH, reader in cardiovascular imaging and center lead in the Advanced Cardiovascular Imaging Centre funded through the NIHR Cardiovascular Biomedical Research Unit in London, and colleagues evaluated data from the UK Biobank on 1,091 postmenopausal women who never used menopausal HT (mean age, 61.3 years; 92% white; mean age at menopause, 50.6 years) and 513 postmenopausal women who used menopausal HT for at least 3 years (mean age, 65.4 years; 93% white; mean age at menopause, 48.3 years; mean age when beginning HT, 47.6 years; median duration of HT, 8 years). Researchers sought to determine the effects of menopausal HT on left ventricular (LV) and left atrial (LA) structure and function.

Participants using menopausal HT compared with those who never used the therapy had smaller LV end-diastolic volume (117 mL vs. 124 mL; P < .0001), LV end-systolic volume (46 mL vs. 48 mL; P < .005), LV stroke volume (71 mL vs. 75 mL; P < .0001) and LA maximal volume (57 mL vs. 61 mL; P < .0001). LV mass did not significantly differ between the two groups.

After full adjustment, menopausal HT use compared with never use was associated with reductions in LV end-diastolic volume (123 mL vs. 120 mL; P = .013), LV stroke volume (74 mL vs. 72 mL; P = .004) and LA maximal volume (60 mL vs. 58 mL; P = .012).

“Use of [menopausal HT] is not associated with adverse, subclinical changes in cardiac structure and function,” the researchers wrote. “Indeed, we demonstrate significantly smaller LV and LA chamber volumes, which have been linked to favorable cardiovascular outcomes in other settings. Our findings provide a novel way to examine the impact of [menopausal HT] on the cardiovascular system.” – by Amber Cox

Disclosures: Petersen reports he receives support from the NIHR Cardiovascular Biomedical Research Centre at Barts and from the “SmartHeart” Engineering and Physical Sciences Research Council program grant. Please see the study for all other authors’ relevant financial disclosures.

itj+ Perspective

Joann Pinkerton

The effect of menopausal hormone therapy on heart health remains unclear. Prior research has shown both positive and negative effects on the cardiovascular system. In this population-based cohort study led by Queen Mary University of London, 1,604 healthy postmenopausal women, free of cardiovascular disease, of whom 32% had used HT for at least 3 years, were evaluated. Significantly lower left ventricular (LV) end-diastolic volume and stroke volume and left axial (LA) maximal volume were found compared with never users of hormone therapy. The smaller LV and LA chamber volumes have been linked to lower mortality and risk for heart failure in other settings. The median duration of menopausal HT use was approximately 8 years, and 15% of women were on therapy at the time of CV imaging.

Limitations of the study included self-reported data about menopause and HT with no information about dose, types of therapy or route of administration. The cross-sectional database analysis does not allow determination of causality or provide information about longitudinal changes in heart structures and functions.

The study provides reassurance that HT used at menopause of 3 years or more had a positive effect on the heart's structure. No adverse changes were seen; instead, changes were seen that are associated with healthier hearts. Findings from the Women’s Health Initiative study suggest fewer heart events when women aged 50 to 59 years start HT, compared with more heart events in women who start HT at older ages (Manson JE, et al. JAMA. 2013;doi: 10.1001/jama.2013.278040; Manson JE, et al. JAMA. 2017;doi: 10.1001/jama.2017.11217). These new data support the “timing hypothesis” — that HT initiated in women closer to menopause, compared with a later stage, may help to prevent atherosclerosis.

For clinicians taking care of menopausal women with bothersome vasomotor symptoms or who are at elevated risk for bone loss, these data are reassuring. The benefits for postmenopausal women starting HT, particularly if younger than 60 years or within 10 years of menopause, may exceed small risks and may provide positive benefits of decreasing their risk of heart disease.

JoAnn V. Pinkerton, MD, NCMP

Executive Director, The North American Menopause Society
Professor of Obstetrics and Gynecology
Division Director Midlife Health
University of Virginia Health System

Disclosure: Pinkerton reports no relevant financial disclosures..