The impact of menopausal hormone therapy (MHT) on cardiac structure and function: Insights from the UK Biobank imaging enhancement study

Mihir M. Sanghvi, Nay Aung, Jackie A. Cooper, José Miguel Paiva, Aaron M. Lee, Filip Zemrak, Kenneth Fung, Ross J. Thomson, Elena Lukaschuk, Valentina Carapella, Young Jin Kim, Nicholas C. Harvey, Stefan K. Piechnik, Stefan Neubauer, Steffen E. Petersen

Research output: Contribution to journalArticle

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Abstract

Background The effect of menopausal hormone therapy (MHT)–previously known as hormone replacement therapy–on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort. Methods Post-menopausal women who had never used MHT and those who had used MHT 3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use 3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a cross-product of age and MHT fitted as an interaction term. Results Of 1604 post-menopausal women, 513 (32%) had used MHT 3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45–52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48–53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4%, 95% CI: -4.2% to -0.5%; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5%, 95% CI: -7.8% to -1.0%; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age. Conclusions MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT’s effect on the cardiovascular system.

Original languageEnglish
Article numbere0194015
JournalPloS one
Volume13
Issue number3
DOIs
Publication statusPublished - 2018 Mar

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menopause
hormones
image analysis
Hormones
Imaging techniques
therapeutics
Therapeutics
Stroke Volume
Magnetic resonance
Menopause
cardiovascular diseases
Cardiovascular Diseases
Left Atrial Function
Cardiovascular system
cardiovascular system
Cardiovascular System

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Sanghvi, M. M., Aung, N., Cooper, J. A., Paiva, J. M., Lee, A. M., Zemrak, F., ... Petersen, S. E. (2018). The impact of menopausal hormone therapy (MHT) on cardiac structure and function: Insights from the UK Biobank imaging enhancement study. PloS one, 13(3), [e0194015]. https://doi.org/10.1371/journal.pone.0194015
Sanghvi, Mihir M. ; Aung, Nay ; Cooper, Jackie A. ; Paiva, José Miguel ; Lee, Aaron M. ; Zemrak, Filip ; Fung, Kenneth ; Thomson, Ross J. ; Lukaschuk, Elena ; Carapella, Valentina ; Kim, Young Jin ; Harvey, Nicholas C. ; Piechnik, Stefan K. ; Neubauer, Stefan ; Petersen, Steffen E. / The impact of menopausal hormone therapy (MHT) on cardiac structure and function : Insights from the UK Biobank imaging enhancement study. In: PloS one. 2018 ; Vol. 13, No. 3.
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title = "The impact of menopausal hormone therapy (MHT) on cardiac structure and function: Insights from the UK Biobank imaging enhancement study",
abstract = "Background The effect of menopausal hormone therapy (MHT)–previously known as hormone replacement therapy–on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort. Methods Post-menopausal women who had never used MHT and those who had used MHT 3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use 3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a cross-product of age and MHT fitted as an interaction term. Results Of 1604 post-menopausal women, 513 (32{\%}) had used MHT 3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45–52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48–53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4{\%}, 95{\%} CI: -4.2{\%} to -0.5{\%}; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5{\%}, 95{\%} CI: -7.8{\%} to -1.0{\%}; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age. Conclusions MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT’s effect on the cardiovascular system.",
author = "Sanghvi, {Mihir M.} and Nay Aung and Cooper, {Jackie A.} and Paiva, {Jos{\'e} Miguel} and Lee, {Aaron M.} and Filip Zemrak and Kenneth Fung and Thomson, {Ross J.} and Elena Lukaschuk and Valentina Carapella and Kim, {Young Jin} and Harvey, {Nicholas C.} and Piechnik, {Stefan K.} and Stefan Neubauer and Petersen, {Steffen E.}",
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Sanghvi, MM, Aung, N, Cooper, JA, Paiva, JM, Lee, AM, Zemrak, F, Fung, K, Thomson, RJ, Lukaschuk, E, Carapella, V, Kim, YJ, Harvey, NC, Piechnik, SK, Neubauer, S & Petersen, SE 2018, 'The impact of menopausal hormone therapy (MHT) on cardiac structure and function: Insights from the UK Biobank imaging enhancement study', PloS one, vol. 13, no. 3, e0194015. https://doi.org/10.1371/journal.pone.0194015

The impact of menopausal hormone therapy (MHT) on cardiac structure and function : Insights from the UK Biobank imaging enhancement study. / Sanghvi, Mihir M.; Aung, Nay; Cooper, Jackie A.; Paiva, José Miguel; Lee, Aaron M.; Zemrak, Filip; Fung, Kenneth; Thomson, Ross J.; Lukaschuk, Elena; Carapella, Valentina; Kim, Young Jin; Harvey, Nicholas C.; Piechnik, Stefan K.; Neubauer, Stefan; Petersen, Steffen E.

In: PloS one, Vol. 13, No. 3, e0194015, 03.2018.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The impact of menopausal hormone therapy (MHT) on cardiac structure and function

T2 - Insights from the UK Biobank imaging enhancement study

AU - Sanghvi, Mihir M.

AU - Aung, Nay

AU - Cooper, Jackie A.

AU - Paiva, José Miguel

AU - Lee, Aaron M.

AU - Zemrak, Filip

AU - Fung, Kenneth

AU - Thomson, Ross J.

AU - Lukaschuk, Elena

AU - Carapella, Valentina

AU - Kim, Young Jin

AU - Harvey, Nicholas C.

AU - Piechnik, Stefan K.

AU - Neubauer, Stefan

AU - Petersen, Steffen E.

PY - 2018/3

Y1 - 2018/3

N2 - Background The effect of menopausal hormone therapy (MHT)–previously known as hormone replacement therapy–on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort. Methods Post-menopausal women who had never used MHT and those who had used MHT 3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use 3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a cross-product of age and MHT fitted as an interaction term. Results Of 1604 post-menopausal women, 513 (32%) had used MHT 3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45–52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48–53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4%, 95% CI: -4.2% to -0.5%; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5%, 95% CI: -7.8% to -1.0%; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age. Conclusions MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT’s effect on the cardiovascular system.

AB - Background The effect of menopausal hormone therapy (MHT)–previously known as hormone replacement therapy–on cardiovascular health remains unclear and controversial. This cross-sectional study examined the impact of MHT on left ventricular (LV) and left atrial (LA) structure and function, alterations in which are markers of subclinical cardiovascular disease, in a population-based cohort. Methods Post-menopausal women who had never used MHT and those who had used MHT 3 years participating in the UK Biobank who had undergone cardiovascular magnetic resonance (CMR) imaging and free of known cardiovascular disease were included. Multivariable linear regression was performed to examine the relationship between cardiac parameters and MHT use 3 years. To explore whether MHT use on each of the cardiac outcomes differed by age, multivariable regression models were constructed with a cross-product of age and MHT fitted as an interaction term. Results Of 1604 post-menopausal women, 513 (32%) had used MHT 3 years. In the MHT cohort, median age at menopause was 50 (IQR: 45–52) and median duration of MHT was 8 years. In the non-MHT cohort, median age at menopause was 51 (IQR: 48–53). MHT use was associated with significantly lower LV end-diastolic volume (122.8 ml vs 119.8 ml, effect size = -2.4%, 95% CI: -4.2% to -0.5%; p = 0.013) and LA maximal volume (60.2 ml vs 57.5 ml, effect size = -4.5%, 95% CI: -7.8% to -1.0%; p = 0.012). There was no significant difference in LV mass. MHT use significantly modified the effect between age and CMR parameters; MHT users had greater decrements in LV end-diastolic volume, LV end-systolic volume and LA maximal volume with advancing age. Conclusions MHT use was not associated with adverse, subclinical changes in cardiac structure and function. Indeed, significantly smaller LV and LA chamber volumes were observed which have been linked to favourable cardiovascular outcomes. These findings represent a novel approach to examining MHT’s effect on the cardiovascular system.

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