Influence of Cardiometabolic Status on Cardiovascular Effects of Oral Menopausal Hormone Therapy.

In 30 seconds

This secondary analysis of two double-blind, placebo-controlled randomized trials examined whether cardiometabolic status modified cardiovascular outcomes of oral menopausal hormone therapy in postmenopausal women aged 50–79 years. The trials compared conjugated equine estrogens (CEE), with or without medroxyprogesterone acetate (MPA), with placebo. Coronary heart disease risk varied by baseline lipid profile: in the CEE+MPA trial, participants with LDL cholesterol of 190 mg/dL or higher had more than twice the risk of those receiving placebo (HR 2.77; 95% CI, 1.42-5.40). Blood pressure, glucose, triglycerides, and metabolic syndrome did not modify risk.

Key findings

• In the CEE+MPA trial, LDL cholesterol of 190 mg/dL or higher was associated with increased CHD risk (HR 2.77; 95% CI, 1.42-5.40; P -trend=.002).
• For untreated participants with LDL cholesterol less than 130 mg/dL, CHD risk with CEE+MPA was similar to placebo (HR 0.59; 95% CI, 0.31-1.10).
• Higher LDL/HDL ratios were associated with greater CHD risk in the CEE+MPA trial; blood pressure, glucose, triglycerides, and metabolic syndrome did not modify risk.
• Prior treatment for hyperlipidemia was not associated with increased CHD risk from either CEE or CEE+MPA compared with placebo.

Why it matters

The findings indicate that baseline lipid status may help explain variation in coronary risk observed with oral menopausal hormone therapy, whereas several other measured cardiometabolic factors did not modify risk. This distinction is relevant when interpreting trial evidence and considering cardiovascular risk in relation to hormone therapy, while recognizing that the results concern specific oral regimens and trial populations.

What to keep in mind

This was a secondary analysis of two trials, and the reported lipid-related risk patterns differ by regimen; some findings, including those for CEE alone, were nonsignificant.