Menopausal Hormone Therapy Linked to Lower CVD Risk

Menopausal hormone therapy (MHT) initiation was associated with an estimated 22% lower risk of cardiovascular disease (CVD) events among perimenopausal and recently postmenopausal women with vasomotor symptoms in an observational target-trial emulation published in JAMA Internal Medicine.

Researchers used 1997-2017 data from the Study of Women’s Health Across the Nation (SWAN), a multiethnic, multicenter, longitudinal cohort study, to emulate a sequence of target trials. Eligible participants were CVD-free women reporting hot flashes and/or night sweats during the prior 2 weeks and with no previous MHT use. The exposure was systemic estrogen with or without progestogens, verified from medication containers.

The analysis included 2737 women, of whom 755 initiated MHT at a mean age of 53.7 years. During 20 years of follow-up, 224 fatal and nonfatal CVD events occurred. Compared with noninitiation, MHT initiation was associated with an adjusted hazard ratio (aHR) of 0.78 (95% CI, 0.62-0.98) for CVD events.

The estimated aHR was 0.73 (95% CI, 0.58-0.93) among women initiating MHT within 10 years of menopause onset and 1.53 (95% CI, 0.66-3.52) among those initiating it more than 10 years from onset (P for interaction = .02). Black women had an estimated aHR of 0.51 (95% CI, 0.33-0.81), while no clear effect was observed among White women or women of other races (P for interaction = .007).

CVD events, including myocardial infarction, stroke, heart failure, and revascularization, were self-reported, while CVD-related deaths were identified from death certificates. The authors cautioned that the observational estimates depend on assumptions required for causal inference and may be affected by residual confounding. Given inconsistent cardiovascular benefits and the need to consider the overall risk-benefit balance, they said the findings should not be used to support MHT for CVD prevention.

Source: Wang Z, Swanson SA, Brooks MM, et al. Menopausal hormone therapy and cardiovascular risk in midlife women with vasomotor symptoms. JAMA Intern Med. Published online September 8, 2026. doi:10.1001/jamainternmed.2026.2922