Association between estrogen replacement therapy and heart failure in postmenopausal women: A systematic review and meta-analysis

Prev Med. 2024 Apr:181:107909. doi: 10.1016/j.ypmed.2024.107909. Epub 2024 Feb 19.


Background: Based on past epidemiological investigations, the cardiovascular role of estrogen replacement therapy (ERT) in postmenopausal women has always been controversial. The real efficacy of ERT for heart failure (HF) among postmenopausal women remains to be further investigated. This article is based on research into European and American populations.

Purpose: To determine the impact of estrogen replacement therapy on HF using meta-analysis.

Methods and material: Electronic literature was searched on Web of Science, PubMed, and Embase databases to identify randomized controlled trials (RCTs) comparing the hospitalization for heart failure between ERT users and non-users among postmenopausal women. Pairs of reviewers screened eligible articles independently, extracted data, and evaluated the risk of bias. Summary relative risks were estimated for the composite endpoint of first hospitalized heart failure and admission to the hospital for heart failure.

Results: A pooled study of five randomized controlled trials found that estrogen replacement therapy had no significant effect on the composite endpoint in postmenopausal women, with a relative risk of 1.02 (95% CI 0.94-1.10).

Conclusion: This systematic review demonstrated that estrogen replacement therapy did not significantly change the risk of first hospitalized heart failure and admission to the hospital for heart failure in postmenopausal women.

Keywords: Estrogen replacement therapy; Heart failure; Meta-analysis; Postmenopausal women; Prevention.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Estrogen Replacement Therapy* / adverse effects
  • Female
  • Heart Failure* / drug therapy
  • Humans
  • Postmenopause
  • Randomized Controlled Trials as Topic