Which statement best describes the role of menopausal hormone therapy in cardiovascular disease prevention?

• A. Recommended for primary prevention in all postmenopausal women.
• B. Not recommended for primary prevention of cardiovascular disease.
• C. Has no effect on cardiovascular risk.
• D. Effective for reducing cardiovascular events in high-risk groups.

Answer: (B)

The main point is that menopausal hormone therapy is not used to prevent cardiovascular disease. Large randomized trials showed no reduction in heart disease or stroke with MHT, and in several analyses it actually raised the risk of cardiovascular events, especially with estrogen-progestin therapy and in older postmenopausal women. Because of this, guidelines discourage using MHT for primary prevention of cardiovascular disease. It remains appropriate for treating menopausal symptoms in carefully selected individuals, but not as a strategy to lower cardiovascular risk. When considering MHT, clinicians weigh symptom relief against potential harms and tailor the approach to the individual, using the lowest effective dose for the shortest duration.