IMPACT OF HORMONE THERAPIES ON CARDIOVASCULAR HEALTH: REVIEW OF CURRENT EVIDENCE

Abstract

Hormone therapies are widely used in the management of conditions such as menopause and hypogonadism, but their impact on cardiovascular health remains controversial. This integrative review aims to synthesize the current evidence on the cardiovascular effects of hormone therapies, including estrogen, progesterone, and testosterone. The search included studies published in the last 20 years, using databases such as PubMed, Scopus, Web of Science, and Embase. Fifteen studies were analyzed, including randomized controlled trials, observational studies, systematic reviews, and meta-analyses. The results indicate a complexity in the effects of hormone therapies on cardiovascular health. Combined estrogen and progesterone hormone replacement therapy (HRT) in postmenopausal women is associated with an increased risk of cardiovascular events, especially in older women or those with pre-existing risk factors. However, early initiation of HRT close to the onset of menopause may offer cardiovascular benefits. Estrogen-alone administration in hysterectomized women presents a distinct risk profile, with possible benefits in reducing coronary heart disease but an increased risk of stroke. Testosterone replacement therapy (TRT) in hypogonadal men also has a complex relationship with cardiovascular health. Some studies indicate an increased risk of cardiovascular events, while others suggest benefits, such as improvements in lipid profile and body composition. The route of administration of hormone therapies is a critical factor, with evidence suggesting that transdermal administration may be associated with lower risks of thromboembolic events compared with oral and intramuscular routes. The review highlights the importance of an individualized assessment of the risks and benefits of hormone therapies, considering the cardiovascular risk profile of each patient. Limitations of the reviewed studies, such as heterogeneity in study designs and reliance on observational data, highlight the need for more well-designed randomized clinical trials with long-term follow-up. Future research should focus on comparing different routes of administration and dosages, in addition to investigating the biological mechanisms underlying the cardiovascular effects of hormone therapies. It is concluded that hormone therapies can have diverse effects on cardiovascular health, influenced by multiple factors. Clinical practice should be guided by a rigorous and individualized assessment of risks and benefits, informed by the most recent evidence. Continued research is essential to improve the safety and efficacy of these therapeutic interventions.