Hormone Replacement Therapy and Postmenopausal Cardiovascular Events: A Meta-Analysis

Context: Hormonereplacement therapy (HRT) is widely used to control postmenopausal symptoms. This therapy is also used to prevent diseases such as osteoporosis and dementia. However, clinical trials suggest some negative effects regarding postmenopausal HRT. This study evaluates the effects of HRT on postmenopausal cardiovascular events. Evidence Acquisition: We collected data from 32 articles by using valid keywords and searching databases of PubMed, Medlib, ScienceDirect, EmBase, Scopus, Index Copernicus, SID, and Iranmedex. Analysis was performed by comparing three groups of postmenopausal women: combined hormone therapy (estrogen + progesterone), estrogen alone treated group, and placebo-receiving group (control group). Data were analyzed using the random effect model meta-analysis by using R software and Stata software Version 11.2. Results: Of the collected 32 studies between 1998 and 2016, there were 1277686 subjects with an average age of 60.6 years. The prevalence of myocardial infarction were (2.64%), coronary heart disease (1.7%), stroke (254%), cardiovascular death (1.54%), revascularization (3.26 %), and cerebrovascular disease (CVD) (2.78%) in the combined hormone therapy group. Also, in the estrogen-treated group were 2.95%, 3.41%, 2.49%, 2.8%, - , 3.14%, respectively. In the placebo-receiving group these events were 2.09%, 2.73%, 2.9%, 2.25%, 4.96%, and 11.92, respectively. The results showed that estrogen therapy could increase the incidence of stroke. Moreover, HRT could have positive effects on the serum lipid profile in postmenopausal women. Conclusion: Postmenopausal HRT appears to be non-effective on coronary artery disease, revascularization, myocardial infarction, and cardiac-related deaths; however, it could play a role in increasing the stroke rate.