A systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies was conducted to assess the association between menopausal hormone therapy and cardiovascular disease. The PubMed and EMBASE databases were searched for articles published from 2000 to 2019, using review methods based on a previous Cochrane review. Quality assessment of RCTs and observational studies was conducted using the Jadad scale and the Newcastle–Ottawa Scale, respectively. A total of 26 RCTs and 47 observational studies were identified. The study populations in the RCTs were older and had more underlying diseases than those in the observational studies. Increased risks of venous thromboembolism [summary estimate (SE), 95% confidence interval (CI): RCTs, 1.70, 1.33–2.16; observational studies, 1.32, 1.13–1.54] were consistently identified in both study types, whereas an increased risk of stroke in RCTs (SE: 1.14, 95% CI: 1.04–1.25) and a decreased risk of myocardial infarction in observational studies (SE: 0.79, 95% CI: 0.75–0.84) were observed. Differential clinical effects depending on timing of initiation, underlying disease, regimen type, and route of administration were identified through subgroup analyses. These findings suggest that underlying disease and timing of initiation should be carefully considered before starting therapy in postmenopausal women.

对随机对照试验（RCT）和观察性研究进行系统回顾和荟萃分析，以评估更年期激素治疗与心血管疾病之间的关联。使用基于之前 Cochrane 综述的综述方法，对 PubMed 和 EMBASE 数据库搜索了 2000 年至 2019 年发表的文章。分别使用贾达德量表和纽卡斯尔-渥太华量表对随机对照试验和观察性研究进行质量评估。总共确定了 26 项随机对照试验和 47 项观察性研究。与观察性研究相比，随机对照试验中的研究人群年龄更大，患有更多基础疾病。静脉血栓栓塞风险增加[总结估计 (SE)，95% 置信区间 (CI)：RCT，1.70、1.33–2.16；观察性研究，1.32，1.13–1.54]在两种研究类型中均得到一致证实，而随机对照试验中卒中风险增加（SE：1.14，95％CI：1.04–1.25），而观察性研究中心肌梗死风险降低（SE：1.14，95％CI：1.04–1.25） ：0.79，95% CI：0.75-0.84）观察到。通过亚组分析确定了不同的临床效果，具体取决于开始时间、基础疾病、治疗方案类型和给药途径。这些发现表明，在绝经后妇女开始治疗之前，应仔细考虑潜在疾病和开始治疗的时间。