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Both menopause and MHT affect cardiovascular risk factors (i.e. blood pressure, lipids, insulin resistance) and cardiovascular events (i.e. myocardial infarction and stroke). Early clinical trial evidence demonstrated that oral synthetic MHT, including conjugated equine estrogen (CEE) with medroxyprogesterone acetate (MPA), is associated with increased coronary heart disease and stroke risk, particularly in older, postmenopausal women. Contemporary formulations such as low-dose transdermal estrogen and micronized progesterone have lower cardiovascular risk. A personalized assessment when initiating MHT should consider age, time since menopause, baseline cardiovascular (CV) risk, and choice of MHT formulation. Assessment of baseline CV risk should include a comprehensive review of traditional CV risk factors and consideration of risk-enhancing factors (including female-specific risk factors) and imaging for subclinical atherosclerosis (i.e. coronary artery calcium scoring) to provide a person-centered risk assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Menopause is an important period to implement prevention strategies to reduce future incidence CVD. A structured, individualized approach that accounts for the timing, formulation and delivery of MHT can optimize cardiovascular safety. This review provides a framework for personalized decision-making and highlights the need for further research to clarify MHT\u2019s impact on long-term CV outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s11883-025-01343-6","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T03:20:37Z","timestamp":1759980037000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Cardiovascular Risk Associated with Menopause and Menopause Hormone Therapy: A Review and Contemporary Approach to Risk Assessment"],"prefix":"10.1007","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0166-3254","authenticated-orcid":false,"given":"Zoee","family":"D\u2019Costa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Spertus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shipra","family":"Hingorany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajita","family":"Patil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara","family":"Horwich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella Calfon","family":"Press","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janki","family":"Shah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karol E.","family":"Watson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lua","family":"Jafari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"1343_CR1","doi-asserted-by":"publisher","unstructured":"Promoting Risk Identification and Reduction of Cardiovascular Disease in Women Through Collaboration. 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