Hormone therapy dose, formulation, route of delivery, and risk of cardiovascular events in women: findings from the Women's Health Initiative Observational Study.
Hormone therapy dose, formulation, route of delivery, and risk of cardiovascular events in women: findings from the Women's Health Initiative Observational Study.
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DOI：
10.1097/gme.0b013e31829a64f9
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发表时间：
2014-03
期刊：
影响因子：
--
通讯作者：
Manson JE
中科院分区：
文献类型：
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作者：
Shufelt CL;Merz CN;Prentice RL;Pettinger MB;Rossouw JE;Aroda VR;Kaunitz AM;Lakshminarayan K;Martin LW;Phillips LS;Manson JE
比较激素治疗（HT）剂量、方案和给药途径与心血管疾病（CVD）结局的研究有限。本研究直接比较了绝经后妇女中不同雌激素剂量、给药途径和HT制剂与冠心病（CHD）、卒中、CVD死亡率、总CVD和全因死亡率风险的关系。妇女健康倡议观察性研究（WHI-OS）是一项在40个美国研究中心进行的多中心前瞻性队列研究。分析包括93，676名绝经后妇女，年龄50-79岁，研究开始时，招募时间为1994年9月至1998年12月，每年随访至2009年8月14日。平均随访10.4年。在直接比较中，与口服结合马雌激素（CEE）相比，口服雌二醇与较低的卒中风险比（HR）相关（HR 0.64; 95% CI 0.40，1.02），但统计功效有限。同样，与口服CEE相比，经皮雌二醇与CHD风险中度但不显著降低相关（HR 0.63; 95% CI 0.37，1.06）。对于其他结果，比较显示雌激素剂量、制剂或递送途径无明显差异。与老年女性相比，年轻女性心血管事件和全因死亡率的绝对风险明显降低。在直接比较中，不同的HT剂量和方案与相似的心血管事件和全因死亡率相关。然而，与常规剂量的口服CEE相比，口服雌二醇可能与较低的中风风险和经皮雌二醇与较低的冠心病风险相关。需要进一步的研究来证实这些假设。
Research comparing hormone therapy (HT) doses, regimens, and routes of delivery in relation to cardiovascular disease (CVD) outcomes have been limited. This study directly compared different estrogen doses, routes of delivery, and HT formulations in postmenopausal women in relation to the risk of coronary heart disease (CHD), stroke, CVD mortality, total CVD, and all-cause mortality. The Women’s Health Initiative Observational Study (WHI-OS) is a multi-center prospective cohort study conducted at 40 US sites. Analyses included 93,676 postmenopausal women, aged 50-79 years at study entry and recruited September 1994 - December 1998, with annual follow-up through August 14, 2009. Average follow-up was 10.4 years. In direct comparisons, oral estradiol was associated with lower hazard ratios (HRs) for stroke than oral conjugated equine estrogens (CEE) (HR 0.64; 95% CI 0.40, 1.02), but statistical power was limited. Similarly, transdermal estradiol was associated with a moderate but non-significant lower risk of CHD compared to oral CEE (HR 0.63; 95% CI 0.37, 1.06). For other outcomes, comparisons revealed no appreciable differences by estrogen doses, formulations, or routes of delivery. Absolute risks of CVD events and all-cause mortality were markedly lower in younger, compared to older, women. In direct comparisons, various HT doses and regimens were associated with similar rates of cardiovascular events and all-cause mortality. However, oral estradiol may be associated with a lower risk of stroke and transdermal estradiol with a lower risk of CHD, compared to conventional-dose oral CEE. Additional research is needed to confirm these hypotheses.