Hormone Replacement Therapy and Heart Disease, “The Window of Opportunity”

According to the Centers for Disease Control and Prevention (CDC), heart disease is the leading cause of death for women in the United States, accounting for about 1 in every 5 female deaths. In fact, in 2021, approximately 314,186 women died from heart disease in the U.S. alone. These statistics underscore the critical importance of addressing cardiovascular health in women, particularly as they age.

However, studies have shown that we have a solution that is not discussed enough: hormone replacement therapy, specifically: estrogen replacement therapy. When initiated before the age of 60 or within 10 years of the onset of menopause, estrogen therapy has shown to reduce the risk of heart disease in women, and in some research, even better than some lipid lowering therapy. 

Understanding the Connection

As estrogen levels decline during menopause, women lose some of the natural protection this hormone provides in the progression of atherosclerosis, i.e. the buildup of plaque believed to be through the following mechanisms:

  • Improved Lipid Profile: Estrogen therapy can help increase HDL (good) cholesterol and decrease LDL (bad) cholesterol, leading to a healthier lipid profile.
  • Reduced Inflammation: Estrogen has anti-inflammatory properties, which can help protect the arteries from damage and plaque buildup.
  • Better Endothelial Function:Hormone Replacement therapy can improve the function of the endothelium, (the inner lining of blood vessels), promoting better blood flow.

The Benefits of Timely Intervention - The Healthy Endothelium Hypothesis

Starting estrogen therapy as close to menopause as possible, ideally within 10 years or before the age of 60 – often referred to as the "window of opportunity" – has been associated with cardiovascular benefits and reduction in all cause mortality. 

  • Lower Risk of Myocardial Infarction (Heart Attack): Women in this age group who used hormone replacement therapy had a 52% lower risk of heart disease. The DOPS (Danish Osteoporosis Prevention Study) found a 52% reduction in coronary heart disease when hormones were initiated at the onset of menopause. It is the longest randomized control trial to date that includes women close to menopause and not with an average age of 65. Previously, through observational studies and meta analysis we found the risk reduction to be between 30-50% of heart disease in women. 
  • Decreased All Cause Mortality: Meta Analyses show a reduced risk of dying from all causes by 30- 39% when hormone replacement therapy is started before the age of 60 or within 10 years of menopause. 

The Importance of Timing

The studies emphasize the critical nature of timing in hormone therapy. The significant benefits observed were specifically for women who initiated therapy closest to menopause. Research shows that when started >10 years after menopause there is a null effect (no effect) on heart disease reduction. 

Conclusion

Given that heart disease is the leading cause of death in  women, and that estrogen replacement given during this “window of opportunity” 

Heart disease is the leading cause of death among women, accounting for about 20% of all female deaths. Therefore starting estrogen therapy during this window of opportunity can potentially reduce this risk is particularly significant. If you’d like to have your hormones evaluated and find out if hormone replacement therapy is right for you, you can call 540-542-1700 to reach out to us to get started.

  • Hodis, Howard N., and Wendy J. Mack. “Menopausal Hormone Replacement Therapy and Reduction of All-Cause Mortality and Cardiovascular Disease.” The Cancer Journal, vol. 28, no. 3, May 2022, pp. 208–223, https://doi.org/10.1097/ppo.0000000000000591. Accessed 26 Oct. 2022.
  • Walsh, Judith M. E. “Drug Treatment of Hyperlipidemia in Women.” JAMA, vol. 291, no. 18, 12 May 2004, p. 2243, https://doi.org/10.1001/jama.291.18.2243. Accessed 28 June 2020.