CARDIOVASCULAR RISK FACTORS OF HORMONE REPLACEMENT THERAPY IN POSTMENOPAUSAL WOMEN: A SYSTEMATIC REVIEW

Resumo

The menopausal transition increases cardiovascular dis ease (CDV) risk in women due to adverse metabolic changes. While estrogen hormone therapy (HT) may have favorable effects on glycemia and lipids, current evidence dictates that HT is nor recommended for primary or secondary CVD prevention. Using HT for vas omotor symptom relief requires strict personalization, as cardiovascular risks vary significantly by formulation, dose and administration Route. Analyze the cardiovascular risk factors of hormone replacement therapy in women after the menopause. This is a systematic literature review encompassing articles from 2021 to 2026 from the PubMed (MEDLINE) database. In total, from the 15 previously selected articles, 10 were chosen using the descriptors "Menopause”, "Hormone Therapy" and "Estrogen". Meta-analyses, systematic reviews and clinical trial in English were included, addressing cardiovascular manifestations in women under the use of estrogen HT. The results showed that oral estrogens contribute to improvements in metabolic parameters, such as lipids and glycemia. However, the association with progestogens may reduce the observed benefits. In addition, estrogens, when administered transdermally, are associated with a lower risk of thromboembolic events and stroke compared to oral estrogens. Clinical outcomes associated with hormonal use do not show a consistent relationship with dose. More specifically, although the use of oral estrogens is associated with a decrease in low -density lipoprotein cholesterol (LDL-C), with approximate reductions of 14.5 to 17.7 mg/dL, suggesting a potential cardioprotective effect, an increase in triglyceride levels of 11.4 to 13.7 mg/dL was also observed, attributed to first-pass hepatic metabolism. Studies have shown that the use of estrogen plus medroxyprogesterone acetate led to an increased risk of heart disease, relative to estrogen alone. In addition, analyses have demonstrated that women who initiate hormone therapy with estrogen alone at a younger age are at lower risk of coronary artery disease compared to those who initiate later. Hormone therapy in postmenopausal women may improve glycemic and lipid parameters, but it should not be used for cardiovascular disease prevention. Cardiovascular effects vary according to formulation, route, timing, and progestogen use. Therefo re, therapy must be individualized, prioritizing symptom relief and careful cardiovascular risk assessment