{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T21:09:56Z","timestamp":1780088996813,"version":"3.54.0"},"reference-count":39,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T00:00:00Z","timestamp":1710115200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the association between menopausal hormonal therapy (MHT) and the risk of cardiovascular disease (CVD), according to various regimens, dosages, routes of administration and starting ages of MHT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A population\u2010based cohort study using the Korean National Health Insurance Services database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Nationwide health insurance database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>Women who reported entering menopause at an age of \u226540\u2009years with no history of CVD in the national health examination.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The study population comprised 1\u2009120\u2009705 subjects enrolled between 2002 and 2019, categorised according to MHT status (MHT group, <jats:italic>n<\/jats:italic>\u2009=\u2009319\u2009007; non\u2010MHT group, <jats:italic>n<\/jats:italic>\u2009=\u2009801\u2009698).<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Incidence of CVD (a composite of myocardial infarction and stroke).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The incidence of CVD was 59\u2009266 (7.4%) in the non\u2010MHT group and 17\u2009674 (5.5%) in the MHT group. After adjusting for confounding factors, an increased risk of CVD was observed with the administration of tibolone (hazard ratio, HR\u20091.143, 95%\u2009CI 1.117\u20131.170), oral estrogen (HR\u20091.246, 95%\u2009CI 1.198\u20131.295) or transdermal estrogen (HR\u20091.289, 95%\u2009CI 1.066\u20131.558), compared with the non\u2010MHT group; the risk was based on an increased risk of stroke. The risk trends were consistent regardless of the age of starting MHT or the physicians\u2019 specialty. Among tibolone users, a longer period from entering menopause to taking tibolone and the use of any dosage (1.25 or 2.5\u2009mg) were linked with a higher risk of CVD, compared with non\u2010MHT users.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This nationwide cohort study demonstrated an increased risk of CVD, driven mainly by an increased risk of stroke, among tibolone and oral or transdermal estrogen users, compared with that of non\u2010MHT users.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17803","type":"journal-article","created":{"date-parts":[[2024,3,11]],"date-time":"2024-03-11T09:20:27Z","timestamp":1710148827000},"page":"1306-1317","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effect of menopausal hormonal therapy on cardiovascular risks in Korean postmenopausal women: A nationwide cohort 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