Chen Z, Wu C, Huang Z Association between estrogen replacement therapy and heart failure in postmenopausal women: A systematic review and meta-analysis. Prev Med. 2024 Apr;181:107909. doi: 10.1016/j.ypmed.2024.107909. Epub 2024 Feb 19. (Systematic review)

BACKGROUND: Based on past epidemiological investigations, the cardiovascular role of estrogen replacement therapy (ERT) in postmenopausal women has always been controversial. The real efficacy of ERT for heart failure (HF) among postmenopausal women remains to be further investigated. This article is based on research into European and American populations.

PURPOSE: To determine the impact of estrogen replacement therapy on HF using meta-analysis.

METHODS AND MATERIAL: Electronic literature was searched on Web of Science, PubMed, and Embase databases to identify randomized controlled trials (RCTs) comparing the hospitalization for heart failure between ERT users and non-users among postmenopausal women. Pairs of reviewers screened eligible articles independently, extracted data, and evaluated the risk of bias. Summary relative risks were estimated for the composite endpoint of first hospitalized heart failure and admission to the hospital for heart failure.

RESULTS: A pooled study of five randomized controlled trials found that estrogen replacement therapy had no significant effect on the composite endpoint in postmenopausal women, with a relative risk of 1.02 (95% CI 0.94-1.10).

CONCLUSION: This systematic review demonstrated that estrogen replacement therapy did not significantly change the risk of first hospitalized heart failure and admission to the hospital for heart failure in postmenopausal women.

Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Gynecology 6 / 7
Cardiology 5 / 7
Endocrine 5 / 7
Comments from MORE raters

Endocrine rater

Well written paper but it doesn't add much to what is already known about the subject.

Endocrine rater

This meta-analysis provides clinically useful information on the potential safety of estrogen replacement therapy in postmenopausal women regarding heart failure events.

Endocrine rater

This meta-analysis sheds light on therole of estrogen replacement therapy (ERT), which is still controversial. Following its high popularity in 1990s, WHI study findings and guidelines led to a rapid decline of its use. However, there are still discrepancies between findings from RCTs and observational studies. This meta-analysis confirms there is no protective benefit of postmenopausal ERT on heart failure (HF) risk and admission to hospital for HF. The review discusses the “timing hypothesis,” showing a benefit trend with early prescription of estrogens. Interestingly, in populations with coronary artery disease, they did not find any benefits in preventing HF. In my view, besides the proven lack of effect on heart failure, the effect of estrogen replacement therapy on reduction of coronary artery disease and cardiac mortality, particularly in younger women, is still worth discussion.

Family Medicine (FM)/General Practice (GP) rater

It is reassuring to know that ERT is unlikely to have an impact on heart failure.

Gynecology rater

With more and more information on non-pharmacological treatments for hot flushes, many move away from conventional hormone therapy. I think many physicians are aware of this.

Gynecology rater

There is so much confusion surrounding the evidence for menopausal HT and cardiovascular safety. Many clinicians are frightened of HT prescribing, even when clinically appropriate. This restrictive practice leads to harm by pushing patients toward alternative practices that sometimes prescribe toxic doses of hormones in a non-evidence-based manner. This adds to the current body of literature showing that in appropriate patients, HT is safe.
Comments from EvidenceAlerts subscribers

No subscriber has commented on this article yet.