A Prospective Multicenter Cohort Study of Contemporary Menopausal Hormone Therapy and Cardiovascular Outcomes

Inclusion Criteria: * female sex * Age 45-75 years at enrollment * Perimenopausal or postmenopausal status documented according to prespecified clinical criteria * Increased cardiovascular risk, defined as SCORE \> 5 % (age 45-69 years) or SCORE2-OP \> 5 % (age \> 70 years), or established disease * Established cardiovascular disease includes coronary artery disease, cerebrovascular disease and/or peripheral artery disease, as specified in the approved protocol * Ability to understand the study procedures and provide written informed consent Exclusion Criteria: * Age \<45 years or \> 75 years * Active malignancy at screening * Inability to provide written informed consent or to comply with study procedures * Severe renal impairment, defined as estimated glomerular filtrate rate \<30 ml/min/1.73m2, or dialysis dependance * Advanced liver disease, defined as Child-Pugh class C * Known genetic cardiomyopathiy