What does this research mean for the field?

Hormone therapy after myocardial infarction did not significantly affect the rate of major adverse cardiac events in women. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To investigate the incidence of major adverse cardiac events in postmenopausal women using hormone therapy after myocardial infarction.

February 8, 2026

Postmenopausal hormone therapy and major adverse cardiac events in women with prior myocardial infarction

Key Result

Postmenopausal hormone therapy after myocardial infarction was not significantly associated with MACE risk (HR 0.95, 95% CI 0.89-1.01) over 3 years.

Key Points

To investigate the incidence of major adverse cardiac events in postmenopausal women using hormone therapy after myocardial infarction.
Analyzed data from Danish women aged ≥50 with first-time myocardial infarction from 2000 to 2021.
Monitored participants for up to three years after myocardial infarction diagnosis.
Defined hormone therapy use as at least one prescription in the first 90 days post-infarction.
Used a Cox proportional hazards model to evaluate the impact of hormone therapy on major adverse cardiac events.
30% (13,169) of women experienced major adverse cardiac events within three years.
25.1% of hormone therapy users experienced major adverse cardiac events compared to 30.5% of non-users.
No significant association between hormone therapy and the rate of major adverse cardiac events (hazard ratio: 0.95).

Structured PICO

Does hormone therapy affect the rate of reinfarction, stroke, or cardiovascular death in women with prior myocardial infarction?

Population

43,932 Danish women ≥ 50 years of age with a first-time acute myocardial infarction who survived at least 90 days, mean age 76.8.

Intervention

Hormone therapy (at least one prescription redemption of a hormone therapy drug in the 90 days following myocardial infarction diagnosis)

Comparator

No hormone therapy prescription redemption in the 90 days following myocardial infarction

Outcome

Composite of reinfarction, stroke, or cardiovascular death (MACE) within 3 yearscomposite

Hormone therapy use following acute myocardial infarction was not associated with an increased rate of reinfarction, stroke, or cardiovascular death, suggesting a need to re-evaluate its absolute contraindication in this population.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Hormone therapy for postmenopausal symptoms is contraindicated in women with a prior cardiovascular event but is still used. Further investigation is needed regarding the risk of a subsequent cardiovascular event in these women. Purpose To investigate the rate of reinfarction, stroke, or cardiovascular death in women using hormone therapy following a myocardial infarction compared to those who did not. Methods All Danish women ≥ 50 years of age with a first-time acute myocardial infarction diagnosis during the study period from January 2000 to December 2021 were identified using the Danish nationwide registers. Time zero was defined as 90 days after their myocardial infarction, and women were followed for up to three years or until the occurrence of a major adverse cardiac event (MACE), all-cause mortality, emigration, or December 31, 2022. Hormone therapy use was defined as at least one prescription redemption of a hormone therapy drug in the 90 days following their myocardial infarction diagnosis. A Cox proportional hazards model, adjusted for age at infarction, calendar year of infarction, income level, diabetes, cancer, peripheral vascular disease, hypertension, kidney disease, heart failure, atrial fibrillation, and chronic obstructive pulmonary disease, was used to estimate the hazard ratio for MACE. MACE was defined as a composite outcome of reinfarction, stroke or cardiovascular death. Results Among 43,932 women who experienced acute myocardial infarction and survived at least 90 days the mean age at time zero was 76.8 (± 9.6) and 4,488 (10.2%) had redeemed a hormone therapy drug prescription. In total, 13,169 (30.0%) experienced MACE within 3 years. Among women using hormone therapy 1,125 (25.1%) experienced MACE while it was 12,044 (30.5%) of those who did not. Hormone therapy was not significantly associated with MACE within 3 years (hazard ratio: 0.95 (95% CI: 0.89-1.01)). Conclusion Hormone therapy use following acute myocardial infarction was not associated with increased or decreased rate of reinfarction, stroke or cardiovascular death. Knowledge about the benefits and possible harms of hormone therapy is important in decision making when treating women for postmenopausal symptoms and should be further investigated.

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