THE RISK OF ACUTE MYOCARDIAL-INFARCTION AFTER ESTROGEN AND ESTROGEN PROGESTOGEN REPLACEMENT
THE RISK OF ACUTE MYOCARDIAL-INFARCTION AFTER ESTROGEN AND ESTROGEN PROGESTOGEN REPLACEMENT
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DOI：
10.1111/j.1471-0528.1992.tb14414.x
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发表时间：
1992-10-01
期刊：
影响因子：
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通讯作者：
NAESSEN, T
中科院分区：
文献类型：
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作者：
FALKEBORN, M;PERSSON, I;NAESSEN, T
目的 确定单独使用雌激素或雌激素-孕激素联合治疗后发生首次急性心肌梗死的相对风险。设计前瞻性队列研究，利用基于处方和记录链接系统进行 1977 年至 1983 年的随访。平均个体观察时间为 5-8 年。设置 乌普萨拉卫生保健区的全部女性人口（1-4 百万居民），占瑞典总人口的六分之一。根据药房记录确定，23 174 名 35 岁及以上的女性在 1977 年至 1980 年间服用了非避孕雌激素。结果 因首次急性心肌梗死入院的情况。结果 总体而言，观察到 227 例首次急性心肌梗死病例，预期为 281.1 例，RR=0.81（95% 置信区间为 0.71 至 0.81）。 0.92）。进入研究时年龄小于 60 岁的女性服用雌二醇化合物 (1-2 mg) 或结合雌激素 (0.625-1.25 mg) 后，相对风险显着降低 30%（RR=0.69、0.54 至 0.86）。那些服用雌二醇-左炔诺孕酮联合品牌的患者也表现出相对风险显着降低（RR=0.53、0.30至0.87）。在随访的第一年，风险估计接近一致，但在随后的几年中有所下降。暴露于弱雌激素雌三醇后不会出现风险。 结论 单独使用雌激素的激素替代疗法，或者与孕激素周期性联合使用，可以降低急性心肌梗塞的风险。
Objective To determine the relative risk of developing a first acute myocardial infarction after treatment with oestrogens alone or oestrogen-progestogen combinations.Design Prospective cohort study utilizing a prescription-based and record linkage system for a follow-up period from 1977 to 1983. Average individual observation time was 5-8 years.Setting The entire female population of the Uppsala Health Care Region (1-4 million inhabitants), one-sixth of the total Swedish population.Subjects 23 174 women aged 35 years and older, identified from pharmacy records as having been prescribed non-contraceptive oestrogens during 1977-1980.Outcomes Admissions to hospitals for first acute myocardial infarctions.Results Overall, 227 cases of a first acute myocardial infarction were observed as against 281.1 expected, RR=0.81 (95 % confidence limits 0.71 to 0.92). Women who were younger than 60 years at entry into the study and prescribed oestradiol compounds (1-2 mg) or conjugated oestrogens (0.625-1.25 mg) showed a significant 30% reduction of the relative risk (RR=0.69, 0.54 to 0.86). Those prescribed a combined oestradiol-levonorgestrel brand also demonstrated a significantly lowered relative risk (RR=0.53, 0.30 to 0.87). The risk estimates were near unity during the first year of follow-up but decreased during subsequent years. Exposure to the weak oestrogen oestriol did not after the risk.Conclusion Hormonal replacement therapy with oestrogens alone, and maybe also when cyclically combined with progestogens, can reduce the risk of acute myocardial infarction.