Nudy says hormone therapy data shows conflicting cardiovascular results

Cardiovascular disease remains the leading cause of death for women both in the United States and globally, creating a critical need for integrated care between OB-GYN providers and cardiology specialists. According to an interview with Contemporary OB/GYN, Nudy emphasizes that assessing cardiovascular risk is no longer just the domain of primary care or cardiologists, but a necessary component of women’s reproductive and menopausal healthcare.

For many women, this period is when subclinical cardiovascular disease—such as coronary artery calcification—can be detected via CT scans. Nudy notes that in menopausal women, elevated coronary artery calcium is strongly associated with the subsequent development of cardiovascular disease.

PREVENT Calculator Helps Clinicians Estimate Cardiovascular Risk

To move from observation to prevention, clinicians are increasingly relying on standardized risk assessment tools. Nudy identifies the PREVENT Calculator from the American Heart Association as a primary tool for estimating a patient’s 10-year risk of experiencing a major cardiovascular event. By inputting demographics, blood pressure, and lab values, providers can determine whether a patient requires preventive therapies, including the initiation of statin medications.

Matthew Nudy, MD, on estrogen and the cardiovascular system

However, medication is not the first line of defense. The clinical priority remains lifestyle modification. Nudy advocates for a comprehensive counseling approach focusing on:

Increasing physical activity and adopting heart-healthy diets, specifically the Mediterranean diet.
Smoking cessation and the elimination of tobacco use.
Weight loss for patients who are overweight or obese.
Reduction of alcohol consumption.

One of the most contested areas of women’s health is the relationship between hormone therapy (HT) used for moderate to severe vasomotor symptoms and heart health. For years, medical consensus has shifted back and forth, often driven by different types of data.

On one side, observational data suggest that hormone therapy might reduce cardiovascular risk. But these findings come with a warning: Nudy points out that this data is often of low methodological quality, plagued by selection bias and “healthy-user bias,” where women who choose HT may already lead healthier lifestyles than those who do not.

On the other side are the gold-standard randomized trials. The Women’s Health Initiative (WHI) and the HERS trial found no cardiovascular benefit from oral conjugated equine estrogen, whether used alone or combined with medroxyprogesterone.

“Specifically, younger menopausal women between the ages of 50 and 59, or women within 10 years of menopause onset, may actually derive cardiovascular benefits from hormone therapy. So I think one of the key messages is that when younger menopausal women use hormone therapy to treat vasomotor symptoms, it appears to be safe from a cardiovascular standpoint and may even offer some benefit.”

Menopause Timing May Improve Hormone Therapy Outcomes

While the broad results of the WHI trial were neutral or negative, a deeper dive into the data suggests a window of opportunity. For women in their 50s or those very close to the onset of menopause, the cardiovascular profile of HT looks significantly more favorable.