# Hormone Replacement Therapy and Cardiovascular Outcomes by Race and Ethnicity: MESA (Multi-Ethnic Study of Atherosclerosis)

## TL;DR

This study found that starting hormone replacement therapy soon after menopause may reduce cardiovascular risks in most groups, but not in Chinese women with certain metabolic issues.

## Contribution

The study reveals race-specific differences in HRT's cardiovascular effects, particularly in Chinese women with metabolic syndrome.

## Key findings

- Early HRT use reduced MACE and mortality in most groups but increased MACE in Chinese participants.
- Chinese women with metabolic syndrome or high triglycerides had higher cardiovascular risks with HRT.
- Benefits of HRT varied significantly by race and metabolic profile.

## Abstract

There is mixed data regarding hormone replacement therapy (HRT) and cardiovascular disease (CVD), particularly on how timing of HRT initiation close to menopause may affect outcomes, and there is little data among different race/ethnicity groups.

The purpose of this study was to how HRT use and cardiovascular outcomes differ by race/ethnicity.

The Multi-Ethnic Study of Atherosclerosis is a prospective epidemiologic study of participants without CVD at enrollment. Outcomes were (1) all-cause mortality and (2) major adverse cardiovascular events (MACEs). Cox models were developed, focusing on the timing of HRT initiation and differences by race/ethnicity (White, Black, Hispanic, and Chinese).

There were 2,427 postmenopausal women with data on HRT and outcomes, followed up for a median of 14 years. HRT use within 5 years of menopause was associated with decreased MACE and all-cause mortality (HR: 0.72 [95% CI: 0.55-0.96] and HR 0.62 [95% CI: 0.48-0.80], respectively). These findings differed by racial/ethnic groups, with Chinese participants on HRT having increased MACE and a trend towards increased mortality (HR: 2.27 [95% CI: 1.06-4.87] and HR: 1.34 [95% CI: 0.73-2.47], respectively). These findings were only seen in Chinese participants who had the metabolic syndrome or elevated triglyceride levels.

We found relative benefit with early initiation of HRT in all race/ethnic groups except Chinese, adding to the complex literature on HRT use in CVD primary prevention. However, Chinese women with the metabolic syndrome or elevated triglycerides may have increased risk of adverse cardiovascular outcomes with HRT, suggesting further research is needed on racial and metabolic differences in the cardiovascular impact of HRT use.