Major clinical findings hormone replacement therapy and prevention of cardiovascular events: a systematic review

Introduction: Cardiovascular disease (CVD) is the leading cause of death in women. Low estrogen levels during menopause are associated with an increased risk of CVD. Therefore, hormone replacement therapy (HRT) can mitigate menopause-related diseases. Vasomotor symptoms affect about 60.0 to 80.0% of postmenopausal women and may have an incidence of 90.0% in perimenopausal women. The main studies in the last 20 years have investigated the effects of estrogen therapy on symptoms and women's health during menopause. Objective: This was to conduct a systematic review to better understand the main findings and discussions of international consensus on hormonal therapies in women regarding cardiovascular events. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to June 2025 in Scopus, Embase, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument, and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 130 articles were found. A total of 39 articles were fully evaluated, and 23 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies at high risk of bias and 25 studies that did not meet the GRADE and AMSTAR-2. It was concluded that hormone replacement therapy is a sex-specific and time-dependent primary cardiovascular disease prevention therapy that concomitantly reduces all-cause mortality as well as other aging-related diseases. Observational studies did not suggest an increased risk of myocardial infarction in postmenopausal women with diabetes prescribed HRT. Lipoprotein, LDL-C, and insulin resistance were lower with hormone therapy, and HDL-C levels were higher with hormone therapy compared to placebo. Thus, hormone therapy in women was shown to be important for improving organic functions and quality of life, as well as showing a bias in reducing cardiovascular events.