The impact of menopausal hormone therapy (MHT) on cardiac structure and function: Insights from the UK Biobank imaging enhancement study.
Mihir M Sanghvi, Nay Aung, Jackie A Cooper, José Miguel Paiva, Aaron M Lee, Filip Zemrak, Kenneth Fung, Ross J Thomson, Elena Lukaschuk, Valentina Carapella, Young Jin Kim, Nicholas C Harvey, Stefan K Piechnik, Stefan Neubauer, Steffen E Petersen
Author Information
Mihir M Sanghvi: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Nay Aung: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Jackie A Cooper: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
José Miguel Paiva: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Aaron M Lee: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Filip Zemrak: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Kenneth Fung: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Ross J Thomson: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
Elena Lukaschuk: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Valentina Carapella: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Young Jin Kim: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Nicholas C Harvey: MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, United Kingdom.
Stefan K Piechnik: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Stefan Neubauer: Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
Steffen E Petersen: William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, Charterhouse Square, London, United Kingdom. ORCID
BACKGROUND: The effect of menopausal hormone therapy (MHT)-previously known as hormone replacement therapy-on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort. METHODS: Post-menopausal women who had never used MHT and those who had used MHT ≥3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use ≥3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a cross-product of age and MHT fitted as an interaction term. RESULTS: Of 1604 post-menopausal women, 513 (32%) had used MHT ≥3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45-52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48-53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4%, 95% CI: -4.2% to -0.5%; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5%, 95% CI: -7.8% to -1.0%; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age. CONCLUSIONS: MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT's effect on the cardiovascular system.
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