Cardiovascular disease is a leading cause of death among men and women worldwide. It encompasses a range of conditions such as heart attacks, strokes, and heart failure.

For decades, researchers have been exploring various approaches to prevent and treat cardiovascular disease. One such approach that has commanded significant attention is hormone therapy.

What is hormone therapy?

Hormone therapy involves the use of medications that contain hormones or hormone-like substances to treat various conditions. It is commonly used to alleviate symptoms of menopause, such as hot flashes, night sweats, and vaginal dryness.

Estrogen and progestin are the hormones most frequently prescribed for hormone therapy in women.

Many women experience a decline in estrogen levels during menopause, which can lead to a variety of unwelcome symptoms.

Hormone therapy works by supplementing the body’s natural hormones to relieve these symptoms and improve overall quality of life.

The potential cardiovascular benefits

In addition to managing menopause symptoms, hormone therapy has been suggested to have potential heart-protective effects. Estrogen, in particular, has been shown to offer several cardiovascular benefits.

It helps to improve arterial function, reduce inflammation, and increase good cholesterol levels (HDL cholesterol). These effects collectively contribute to a lowered risk of cardiovascular diseases.

Several large-scale studies have investigated the link between hormone therapy and cardiovascular disease.

The Women’s Health Initiative (WHI), a landmark clinical trial involving over 160,000 postmenopausal women, explored the effects of hormone therapy on heart health. The study yielded valuable insights regarding the benefits and risks associated with hormone therapy.

The findings from the Women’s Health Initiative

The WHI study provided evidence supporting the notion that hormone therapy can have heart-protective effects. The trial included two arms: estrogen-only therapy and estrogen plus progestin therapy.

Results showed a reduced risk of coronary heart disease and heart attacks in women who initiated hormone therapy within a few years of entering menopause.

However, these heart-protective effects were not observed in older women, or those who initiated hormone therapy many years after menopause. In fact, in older women, hormone therapy appeared to increase the risk of cardiovascular events.

This finding highlights the importance of timing when it comes to hormone therapy and its potential cardiovascular benefits.

The importance of timing

The timing hypothesis suggests that hormone therapy may provide different cardiovascular benefits depending on when it is started relative to menopause.

The protective effects of hormones on the heart may be more pronounced if therapy is initiated close to the onset of menopause, as opposed to years later.

During the early stages of menopause, estrogen levels decline rapidly, and blood vessels undergo changes that contribute to increased cardiovascular risk.

Initiating hormone therapy during this critical period may help to counteract these changes and preserve cardiovascular health.

Duration of hormone therapy and heart protection

Another crucial aspect of hormone therapy’s heart-protective effects is its duration. Most studies examining hormone therapy have focused on short-term use, typically up to 5 years.

The effects of long-term hormone therapy on heart health remain less understood.

It is important to consider the risks associated with hormone therapy when evaluating its heart-protective effects.

Hormone therapy, especially when combined with progestin, has been associated with an increased risk of certain conditions, including breast cancer, blood clots, and stroke. However, some experts argue that the benefits of hormone therapy may outweigh the risks for certain individuals.

Prolonged use of hormone therapy should be carefully considered on an individual basis, taking into account factors such as age, overall health, and personal risk factors for cardiovascular disease.

Recent studies and updated guidelines

In recent years, new studies have emerged, shedding light on the long-term effects of hormone therapy on heart health. The findings have led to updated guidelines regarding hormone therapy use in postmenopausal women.

The American Heart Association and the North American Menopause Society both acknowledge that hormone therapy can be reasonable for the treatment of menopause symptoms in healthy, younger women who are within 10 years of menopause onset.

However, they caution against the long-term use of hormone therapy solely for the purpose of reducing the risk of cardiovascular disease.

The bottom line

While hormone therapy may have heart-protective effects, particularly when initiated soon after menopause, the advantages and risks must be carefully considered.

Hormone therapy should not be solely relied upon for the prevention or treatment of cardiovascular disease. A comprehensive approach to heart health, including lifestyle modifications and regular check-ups, is essential for reducing the risk of cardiovascular events.