Researchers analysing data from 920,000 menopausal women found those taking HRT tablets containing both oestrogen and progestogen were more likely to develop ischemic heart disease or a blood clot
Women taking certain forms of hormone replacement therapy drugs could be at slightly higher risk of heart attacks, research suggests.
Swedish researchers have analysed data on 920,000 menopausal women from 138 studies and found women taking HRT tablets containing both oestrogen and progestogen were more likely to develop ischemic heart disease or a blood clot. Another HRT tablet called tibolone was associated with an increased risk of heart disease, heart attack and stroke.
Lead author Therese Johansson, of Uppsala University, said: “These findings highlight the diverse effects of different hormone combinations and administration methods on the risk of cardiovascular disease.”
The study, published in the BMJ, showed increased risk of heart disease for both types of HRT was equivalent to 11 new cases of ischaemic heart disease per 1,000 women who take the drug for over one year.
It comes after a landmark NHS review earlier this month concluded HRT drugs do not shorten women’s lifespan on average, despite coming with a slightly higher risk of breast cancer. That is because this increased risk is balanced by other benefits such as improved bone health as a result of taking HRT and a lower risk of fractures in old age. Updated guidance from the National Institute for Health and Care Excellence confirmed HRT remains the first choice option for the menopause.
Study participants were aged between 50 and 58 between 2007 and 2020 and 24,089 cardiovascular events were recorded during the study period. Rachel Richardson, expert at the Cochrane institute, said: “This is still an observational study, and the influence of potential confounding variables cannot be ruled out. For example, the authors were not able to take BMI into account. It may be that doctors were more likely to prescribe particular types of HRT to women with obesity, and obesity is also a risk factor for heart disease.”
Earlier draft guidance had suggested cognitive behavioural therapy (CBT) could be offered instead but this had sparked anger among some campaign groups. The new update said it should be only offered as well as HRT or if women were unable to take HRT. The strengthened guidance said “HRT is the preferred, recommended approach” for managing symptoms such as hot flushes, insomnia and low mood.
The draft NICE guidance had caused anger among campaigners who argued women still struggle to get HRT on the NHS amid concerns some would now be prescribed CBT instead. NHS data shows women are three times more likely to be offered HRT in wealthier areas than in less well off parts of the country. Campaigners have warned that women too often have to be “sharp elbowed and middle-class” to persuade GPs to prescribe the drugs.
CBT is a talking therapy designed to help people manage their problems by changing the way they think and behave. Techniques include learning to break free from unhelpful thinking habits and developing coping strategies. The NICE guidance will be delivered to doctors across the NHS in the form of a “discussion aid” to help them advise women considering starting HRT.