Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
National Clinical Research Center for Chinese Medicine Cardiology, Beijing, 100091, China.
BMC Womens Health. 2024 Jan 23;24(1):60. doi: 10.1186/s12905-023-02788-0.
Menopause hormone therapy (MHT), as an effective method to alleviate the menopause-related symptoms of women, its benefits, risks, and potential influencing factors for the cardiovascular system of postmenopausal women are not very clear.
To evaluate cardiovascular benefits and risks of MHT in postmenopausal women, and analyze the underlying factors that affect both.
The EMBASE, MEDLINE, and CENTRAL databases were searched from 1975 to July 2022.
Randomized Clinical Trials (RCTs) that met pre-specified inclusion criteria were included.
Two reviewers extracted data independently. A meta-analysis of random effects was used to analyze data.
This systematic review identified 33 RCTs using MHT involving 44,639 postmenopausal women with a mean age of 60.3 (range 48 to 72 years). There was no significant difference between MHT and placebo (or no treatment) in all-cause death (RR = 0.96, 95%CI 0.85 to 1.09, I = 14%) and cardiovascular events (RR = 0.97, 95%CI 0.82 to 1.14, I = 38%) in the overall population of postmenopausal women. However, MHT would increase the risk of stroke (RR = 1.23, 95%CI 1.08 to 1.41,I = 0%) and venous thromboembolism (RR = 1.86, 95%CI 1.39 to 2.50, I = 24%). Compared with placebo, MHT could improve flow-mediated arterial dilation (FMD) (SMD = 1.46, 95%CI 0.86 to 2.07, I = 90%), but it did not improve nitroglycerin-mediated arterial dilation (NMD) (SMD = 0.27, 95%CI - 0.08 to 0.62, I = 76%). Compared with women started MHT more than 10 years after menopause, women started MHT within 10 years after menopause had lower frequency of all-cause death (P = 0.02) and cardiovascular events (P = 0.002), and more significant improvement in FMD (P = 0.0003). Compared to mono-estrogen therapy, the combination therapy of estrogen and progesterone would not alter the outcomes of endpoint event. (all-cause death P = 0.52, cardiovascular events P = 0.90, stroke P = 0.85, venous thromboembolism P = 0.33, FMD P = 0.46, NMD P = 0.27).
MHT improves flow-mediated arterial dilation (FMD) but fails to lower the risk of all-cause death and cardiovascular events, and increases the risk of stroke and venous thrombosis in postmenopausal women. Early acceptance of MHT not only reduces the risk of all-cause death and cardiovascular events but also further improves FMD, although the risk of stroke and venous thrombosis is not reduced. There is no difference in the outcome of cardiovascular system endpoints between mono-estrogen therapy and combination therapy of estrogen and progesterone.
绝经激素治疗（MHT）作为一种有效缓解女性绝经相关症状的方法，其对绝经后女性心血管系统的益处、风险和潜在影响因素尚不清楚。
评估 MHT 对绝经后女性的心血管获益和风险，并分析影响两者的潜在因素。
对 1975 年至 2022 年 7 月的 EMBASE、MEDLINE 和 CENTRAL 数据库进行检索。
符合预先设定纳入标准的随机临床试验（RCT）。
两名评审员独立提取数据。使用随机效应模型进行荟萃分析来分析数据。
本系统评价共纳入 33 项使用 MHT 的 RCT，涉及 44639 名绝经后女性，平均年龄为 60.3（范围 48 至 72 岁）。在绝经后女性总体人群中，MHT 与安慰剂（或无治疗）相比，全因死亡（RR=0.96，95%CI 0.85 至 1.09，I²=14%）和心血管事件（RR=0.97，95%CI 0.82 至 1.14，I²=38%）无显著差异。然而，MHT 会增加中风（RR=1.23，95%CI 1.08 至 1.41，I²=0%）和静脉血栓栓塞（RR=1.86，95%CI 1.39 至 2.50，I²=24%）的风险。与安慰剂相比，MHT 可改善血流介导的动脉扩张（FMD）（SMD=1.46，95%CI 0.86 至 2.07，I²=90%），但不能改善硝酸甘油介导的动脉扩张（NMD）（SMD=0.27，95%CI -0.08 至 0.62，I²=76%）。与绝经后 10 年以上开始 MHT 的女性相比，绝经后 10 年内开始 MHT 的女性全因死亡（P=0.02）和心血管事件（P=0.002）的发生率较低，FMD 改善更显著（P=0.0003）。与雌酮治疗相比，雌孕激素联合治疗并不会改变终点事件的结局。（全因死亡 P=0.52，心血管事件 P=0.90，中风 P=0.85，静脉血栓栓塞 P=0.33，FMD P=0.46，NMD P=0.27）。
MHT 可改善血流介导的动脉扩张（FMD），但不能降低绝经后女性的全因死亡和心血管事件风险，并增加中风和静脉血栓栓塞的风险。早期接受 MHT 不仅降低了全因死亡和心血管事件的风险，而且进一步改善了 FMD，尽管中风和静脉血栓栓塞的风险没有降低。雌酮治疗与雌孕激素联合治疗对心血管系统终点结局无差异。
