Hi @debbie1956 thank you very much for posting this podcast link. It summarizes the current view/approaches well, especially for those of us who are 10 years past menopause. The “timing hypothesis” has been discussed here and there are published papers available on this topic.

Regarding cardiovascular risk related to HRT use, there is an article I came across by Cleveland Clinic worth reading:
https://consultqd.clevelandclinic.org/menopausal-hormone-therapy-and-heart-risk-updated-guidance-is-at-hand
In this article, the risks were stratified to 3 categories:

“In keeping with the guidelines from the four medical societies, the ACC committee advises cardiologists to take a risk-stratified approach to HT, as follows:

Treatment is low-risk in women with recent menopause, normal weight and normal blood pressure who are physically active and have a 10-year atherosclerotic cardiovascular disease (ASCVD) risk < 5% as well as a low risk for breast cancer.
Treatment is intermediate-risk in women who have one or more of several risk factors (diabetes, smoking, hypertension, obesity, sedentary lifestyle or limited mobility, autoimmune disease, hyperlipidemia, metabolic syndrome) and those who have a 10-year ASCVD risk from 5% to 10% or are at high risk for breast cancer.
Treatment is high-risk in women who have congenital heart disease, ASCVD or coronary/peripheral artery disease, venous thromboembolism (VTE) or pulmonary embolism, stroke/transient ischemic attack or myocardial infarction, breast cancer or a 10-year ASCVD risk ≥ 10%.”

The article also provided a link for an in depth review by Dr. Leslie Cho, a Cleveland clinic cardiologist.

I was under the care of my current cardiologist for 3 years then sought a second opinion of a cardiologist who specializes women’s heart recently. They both concluded that HRT is suitable for me as far as cvd risk is considered, even though I had a cac score of 38. I had numerous tests done and labs are followed closely for the past 3 years. The cardiology specialist wanted the target for my LDL-c below 55 and HbA1c below 5.6, a stricter target than the one I previously followed. Now looking at the stratified category, I realize I’m between low and intermediate risk. Maybe that’s why the specialist adjusted target bio parameters lower.

Hope this article is helpful to someone seeking cvd risk related information.

Wish you a smooth process going forward, and that HRT works for your needs!