Association of menopausal hormone therapy with incident cardiovascular disease in women veterans

Abstract Aims The impact of menopausal hormone therapy (HT), and its timing on cardiovascular disease (CVD) remains controversial in women. The aim of the study is to examine the association of HT with incident CVD in women veterans (WV). Methods and results Veterans Health Administration (VHA) electronic records were used to identify WV aged ≥45 years who engaged with VHA from 1/1/2000-12/31/2017. HT was defined as any oral or transdermal oestrogen-containing product or combined oestrogen–progestin. Incident CVD was defined as new-onset ischaemic heart disease (IHD), stroke, heart failure (HF), atrial fibrillation/flutter (AF), aortic stenosis (AS), pulmonary hypertension (PHTN), venous thromboembolism (VTE), and peripheral arterial disease (PAD). Propensity score matching was used to match WV with and without HT on demographics, CVD risk factors, mental health conditions, and cardiovascular medication use. Cox proportional hazards models were used to estimate hazard ratios. Stratified analyses were conducted across distinct age categories. A total of 241 943 WV met the inclusion criteria, including 9295 with HT. After 1:2 propensity score matching, the HT cohort had significantly higher rates of CVD compared to the non-HT cohort (22.4% vs. 11.7%, P < 0.001), and all-cause mortality (8.0% vs. 5.2%, P < 0.001). In the Cox proportional hazards regression model, HT was independently associated with a greater risk of CVD (HR = 1.74, 95% CI: 1.63–1.85), Death (HR = 1.25 95% CI: 1.13–1.39), and IHD, stroke, HF, AF, AS, PHTN, PAD, and VTE. Conclusion Our results suggest that menopausal HT is associated with increased risk of a broad range of CVD and death in WV 45 years and older.