Postmenopausal estrogen and progestin use and the risk of cardiovascular disease
Postmenopausal estrogen and progestin use and the risk of cardiovascular disease
复制标题
DOI：
10.1056/nejm199608153350701
复制
发表时间：
1996-08-15
影响因子：
158.5
通讯作者：
Hennekens, CH
中科院分区：
文献类型：
--
作者：
Grodstein, F;Stampfer, MJ;Hennekens, CH
背景绝经后妇女的雌激素治疗与心脏病风险降低有关。有很少的信息，但是，关于联合雌激素和孕激素治疗对心血管疾病的风险的影响。方法我们研究了心血管疾病和绝经后激素治疗之间的关系，在长达16年的随访期间，在59,337名妇女从护士健康研究，谁是30至55岁的基线。使用激素的信息，确定了两年一次的问卷调查。从1976年到1992年，我们记录了770例心肌梗塞或死于冠心病的病例和572例中风。使用比例风险模型来计算相对风险和95%置信区间，并针对混杂变量进行调整。结果我们观察到，与未使用激素的女性相比，服用雌激素和孕激素的女性患重大冠心病的风险显着降低（多变量校正的相对危险度，0.39; 95%置信区间，0.19至0.78）或单独使用雌激素（相对危险度，0.60; 95%置信区间，0.43至0.83）。然而，中风和联合激素的使用之间没有显著的联系（多变量校正的相对危险度，1.09; 95%置信区间，0.66 - 1.80）或单独雌激素（相对危险度，1.27; 95%的置信区间，结论：增加雌激素没有减弱绝经后雌激素治疗的心脏保护作用。(C)1996年，马萨诸塞州医学会。
Background Estrogen therapy in postmenopausal women has been associated with a decreased risk of heart disease. There is little information, however, about the effect of combined estrogen and progestin therapy on the risk of cardiovascular disease.Methods We examined the relation between cardiovascular disease and postmenopausal hormone therapy during up to 16 years of follow-up in 59,337 women from the Nurses' Health Study, who were 30 to 55 years of age at base line. Information on hormone use was ascertained with biennial questionnaires. From 1976 to 1992, we documented 770 cases of myocardial infarction or death from coronary disease in this group and 572 strokes. Proportional-hazards models were used to calculate relative risks and 95 percent confidence intervals, adjusted for confounding variables.Results We observed a marked decrease in the risk of major coronary heart disease among women who took estrogen with progestin, as compared with the risk among women who did not use hormones (multivariate adjusted relative risk, 0.39; 95 percent confidence interval, 0.19 to 0.78) or estrogen alone (relative risk, 0.60; 95 percent confidence interval, 0.43 to 0.83). However, there was no significant association between stroke and use of combined hormones (multivariate adjusted relative risk, 1.09; 95 percent confidence interval, 0.66 to 1.80) or estrogen alone (relative risk, 1.27; 95 percent confidence interval, 0.95 to 1.69).Conclusions The addition of progestin does not appear to attenuate the cardioprotective effects of postmenopausal estrogen therapy. (C) 1996, Massachusetts Medical Society.