TL;DR
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An Israeli observational study of 52,330 women ages 45 to 59 found no higher rates of heart attack, stroke, blood clots or death before age 80 among those who started contemporary hormone replacement therapy (HRT), compared with women who did not. The results, based on an average 12 years of follow-up, are preliminary and cannot establish that HRT causes no cardiovascular harm.
A study tracking 52,330 women in Israel found that those who started contemporary hormone replacement therapy had similar rates of heart attack, stroke, blood clots and death before age 80 to women who did not take HRT. The preliminary findings, based on an average of 12 years of follow-up, are due to be presented at the American Heart Association’s Scientific Sessions in Chicago on Nov. 6-9, 2026; because the research is observational, it cannot prove that HRT itself does not affect cardiovascular risk.
The researchers examined health records for women ages 45 to 59 who had no recorded history of cardiovascular disease, blood clots or cancer. Half had started HRT, primarily taken orally or through the skin by patch; the comparison group had recently visited a gynecologist but had not started HRT and did not use it during the study period. The researchers matched participants on age, body mass index, blood pressure, cholesterol, diabetes, smoking and socioeconomic status.
During follow-up, 2,311 women in the HRT group (4.4%) experienced a heart attack, stroke or related heart disease, compared with 2,383 women (4.6%) in the non-HRT group. Blood clots were recorded in 174 HRT users and 175 nonusers, or 0.33% in each group. Death before age 80 occurred in 659 women taking HRT (1.3%) and 653 women not taking it (1.2%). The report says results were similar across HRT formulations and routes, including oral medication, patches and gels.
Records were assessed for up to 23 years, with 12 years as the average follow-up. The outcomes covered cardiovascular disease, venous thromboembolism and death from any cause before age 80. The figures show closely similar observed outcomes in these matched groups; they do not establish that the treatments have identical effects for every patient or in every population.
What the Findings Mean for HRT Decisions
Cardiovascular concerns can affect whether women consider HRT for menopause symptoms and whether clinicians offer it. The study adds long-term observational data on currently used hormone therapies in women who were free of diagnosed cardiovascular disease at the study’s start. Its follow-up period and comparison of more than 52,000 participants make it relevant to discussions about treatment near the menopause transition.
The findings do not settle the safety question for all women. The study was not randomized, and its results apply most directly to women resembling those included: ages 45 to 59 without recorded heart disease, blood clots or cancer. Treatment decisions still depend on a person’s health history, symptoms and the specific therapy being considered. The American Heart Association’s Stacey E. Rosen, who was not involved in the research, said the results may help women and healthcare teams have more informed conversations about individual benefits and risks.
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How Modern HRT Safety Became a Question
Earlier randomized trials linked HRT with possible cardiovascular harm, but the report says those findings were mixed and much of the evidence involved older formulations, higher doses or women who began treatment long after menopause. That distinction matters because this study examined contemporary HRT use among women in midlife, rather than treating all hormone therapy and timing of treatment as the same.
Current American College of Obstetricians and Gynecologists guidance recommends starting HRT within 10 years of menopause onset and before age 60. In November 2025, the U.S. Food and Drug Administration removed black-box warnings from HRT products after reviewing scientific data, according to the source report. The new study is scheduled for presentation at the American Heart Association’s 2026 meeting; its findings are preliminary and should be read alongside the wider evidence, not as a replacement for clinical guidance.
““Our results indicate that, for women in their mid-forties to late fifties with no history of heart disease or blood clots, the currently available hormone therapies prescribed to manage menopause symptoms do not appear to raise the risk of heart attack, stroke, clots or early death, even after long-term use.””
— Ronen Arbel, Ph.D., lead study researcher
Limits of the Observational Evidence
The study compared existing health records rather than randomly assigning women to HRT or no HRT. It therefore shows an association between treatment status and recorded outcomes, but cannot determine whether HRT caused, prevented or had no effect on those outcomes. The researchers also noted that records may not capture other differences between the groups, including exercise habits.
The report does not provide detailed results for every formulation, dose, duration or subgroup, nor does it establish how findings apply to women with prior cardiovascular disease, blood clots or cancer. It also describes the findings as preliminary, ahead of their conference presentation. Whether further analyses or peer-reviewed publication will change or clarify the interpretation is not yet stated.
Conference Presentation and Further Review
The researchers are scheduled to present the findings at the American Heart Association Scientific Sessions in Chicago, running Nov. 6-9, 2026. The presentation may provide further detail on the study methods, event definitions and analyses. Until then, the results are a conference-bound report of observational research, not proof of a treatment effect.
For readers considering HRT, the immediate practical point is that these group-level results do not determine an individual’s risk. Women can discuss their symptoms, medical history and treatment options with a qualified healthcare professional. Further interpretation will depend on the full conference presentation and any subsequent publication or independent assessment of the research.
Key Questions
What did the study find about HRT and heart health?
Among 52,330 women ages 45 to 59, researchers found similar recorded rates of heart attack, stroke or related heart disease in HRT users and nonusers: 4.4% and 4.6%, respectively. Blood-clot rates were 0.33% in both groups. The observational study cannot prove that HRT caused these outcomes or had no effect.
How long were the women followed?
Health records covered up to 23 years, with an average follow-up of 12 years.
Does this mean HRT is safe for every woman?
No. The study included women ages 45 to 59 without recorded prior cardiovascular disease, blood clots or cancer. Its findings may not apply to people outside that group, and they do not replace individualized advice from a qualified healthcare professional.
Can the study prove that modern HRT does not raise cardiovascular risk?
No. It was an observational study based on health records, not a randomized trial. Unmeasured differences between participants may affect the results, so the study can report similar outcomes but cannot establish cause and effect.
When will the findings be presented?
The findings are scheduled for presentation at the American Heart Association Scientific Sessions in Chicago, Nov. 6-9, 2026.
Source: news-medical.net
