#370 : Hormone Replacement Therapy and Risk of Cardiovascular Diseases in Postmenopausal Women Aged 50-59 Years: A Systematic Review of Randomized Controlled Trials

Abstract

Background and Aims: Cardiovascular diseases are the leading cause of mortality worldwide. Due to declining estrogen levels, women are at higher risk of contracting cardiovascular diseases. Although hormone replacement therapy (HRT) has the potential to prevent cardiovascular diseases, its safety and efficacy are still controversial. The window of opportunity theory suggests that initiating HRT during the early stages of menopause could have the most significant benefits. This review aims to assess available evidence on the effects of HRT in preventing cardiovascular disease in early postmenopausal women aged 50-59 years old. Method: Systematic literature searching was conducted on four databases: Pubmed, EMBASE, EBSCOhost, and ProQuest. Using previously designed keywords, we searched for randomized controlled trials assessing the association between HRT and various cardiovascular outcomes. Critical appraisal was conducted using the Cochrane Risk of Bias 2.0. Results: Six post-interventional analyses from 2 randomized controlled trials with a total of 9,838 subjects were included. The review only assessed the data from subjects aged 50-59 years old without any known comorbidities. Despite varying statistical significance among studies, we observed a relatively consistent trend that estrogen-only HRT lowers the risk of cardiovascular events, thus supporting the window of opportunity theory. However, there was also an increase in the risk of cardiovascular events in estrogen-progesterone combination compared to placebo or estrogen-only HRT. Conclusion: By taking into account aspects of patient characteristics, age during first administration, regimens, and therapy duration, hormone replacement therapy has the potential to prevent cardiovascular diseases in early postmenopausal women aged 50-59 years old.