What is the effect of hormone therapy on cardiovascular disease risk?

• A. HT reduces risk of CVD in postmenopausal women.
• B. HT is not recommended for primary prevention; timing may affect risk.
• C. HT guarantees prevention of stroke.
• D. HT is recommended for all with menopausal symptoms regardless of risk.

Answer: (B)

The key idea is that hormone therapy does not reliably lower cardiovascular disease risk, and its effect depends on timing relative to menopause. Large trials show no overall reduction in heart disease for women starting HT, and some cardiovascular risks (like stroke and blood clots) can be increased, especially in older women or when HT is used long-term. The timing hypothesis suggests that starting HT closer to menopause—within about 10 years or before age 60—may have a different, sometimes neutral or less harmful, impact on the heart and vessels than starting later. Because of this, HT is not recommended for primary prevention of cardiovascular disease. It should be used mainly to treat menopausal symptoms, with careful attention to individual risk factors, using the lowest effective dose for the shortest duration.