Association between menopausal hormone therapy and cardiovascular disease risk in women with prediabetes or type 2 diabetes

By Samar Mahmoud, MS
Published January 28, 2022

Key Takeaways

  • Menopausal hormone therapy (MHT) is associated with decreased risk of cardiovascular disease (CVD) among White, but not Black, women with prediabetes (PreDM) or type 2 diabetes (T2DM). 

  • Race was found to be an effect modifier in the association between MHT use and risk of CVD. 

  • Large, prospective cohort studies are needed to verify these results.

Cardiovascular disease is the leading cause of death for women in the United States. Female-specifc risk factors, such as menopause, have previously been associated with increased CVD risk in women.

Why This Study Matters 

Due to the limited inclusion of participants with T2DM in clinical trials, information on the effect of MHT use on CVD outcomes in this population is currently lacking. To address this need, this study evaluated the link between any or early use MHT and CVD risk in postmenopausal women with preDM or T2DM.

Study Design

The study included 2917 postmenopausal women with PreDM or T2DM pooled from 3 prospective CVD cohorts (the Atherosclerosis Risk in Communities, the Multi-Ethnic Study of Atherosclerosis, and the Jackson Heart Study). 

Investigators evaluated the link between any (yes vs no) or early use of MHT (MHT use initiated ≤5 vs > 5 years since menopause) and risk of ischemic stroke, coronary heart disease (CHD), and atherosclerotic cardiovacular diseease (ASCVD).  The study had a median follow-up period of 15 years. 

Results and Conclusions

Investigators documented 264, 484, and 659 instances of stroke, CHD, and ASCVD, respectively, during the follow-up period. 

Any use of MHT was associated with reduced risk of stroke (hazard ratio 0.86) , CHD (hazard ratio 0.85), and ASCVD (hazard ratio 0.83) in White women with PreDM or T2DM.  Similarly, early MHT use was associated with reduced risk of stroke (hazard ratio 0.82), CHD (hazard ratio 0.85), and ASCVD (hazard ratio 0.82) in the White group. 

Investigators did not observe any risk reduction with any or early use of MHT for Black women with PreDM or T2DM. 

Related Research

Consider these findings from similar research studies:

  • MHT use is not associated with adverse, subclinical changes in cardiac structure and function in post-menopausal women without cardiovasclar disease (Source). 

  • Menopausal hormone therapy is not associated with risk of long-term all-cause death during a follow-up of 18 years (Source).

Original Source 

Yoshida Y, Chen Z, Baudier RL, et al. Menopausal hormone therapy and risk of cardiovascular events in women with prediabetes or type 2 diabetes: A pooled analysis of 2917 postmenopausal women. Atherosclerosis. Published online January 2022:S0021915022000302.

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