Effect of oral postmenopausal hormone replacement on progression of atherosclerosis -: A randomized, controlled trial
Effect of oral postmenopausal hormone replacement on progression of atherosclerosis -: A randomized, controlled trial
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DOI：
10.1161/01.atv.21.2.262
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发表时间：
2001-02-01
影响因子：
8.7
通讯作者：
von Schacky, C
中科院分区：
文献类型：
--
作者：
Angerer, P;Störk, S;von Schacky, C
在流行病学研究中，激素替代疗法（HRT）与低心血管发病率和死亡率相关。然而，没有随机试验研究HRT是否能有效预防风险增加的女性冠心病（CHD）。本研究的目的是确定HRT是否可以减缓动脉粥样硬化的进展，测量颈动脉内膜中层厚度（IMT）。颈动脉IMT是研究动脉粥样硬化形成的临床相关效应的适当中间终点。这项随机、对照、双盲、临床、单中心试验入组了321名健康绝经后女性，她们颈动脉IMT大于或等于1段。在48周的时间内，受试者接受1 mg/d的17 β-雌二醇连续加0.025mg孕二烯酮，每月12天（标准孕酮组），或1 mg 17 β-雌二醇加0.025mg孕二烯酮，每三个月12天（低孕酮组），或不接受HRT。采用B型超声测量介入前后颈总动脉、分叉动脉、颈内动脉6个节段的最大IMT。HRT不能减缓颈动脉IMT进展。无HRT组颈动脉平均最大IMT增加0.02 ± 0.05 mm，HRT组分别增加0.03 ± 0.05和0.03 ± 0.05 mm（P>0.2）。HRT显著降低LDL胆固醇、纤维蛋白原和促卵泡激素。总之，1年的HRT对减缓绝经后亚临床动脉粥样硬化的进展无效。
hormone replacement therapy (HRT) is associated with low cardiovascular morbidity and mortality in epidemiological studies. Yet, no randomized trial has examined whether HRT is effective for prevention of coronary heart disease (CHD) in women with increased risk. The objective of this study was to determine whether HRT can slow progression of atherosclerosis, measured as intima-media thickness (IMT) in carotid arteries. Carotid IMT is an appropriate intermediate end point to investigate clinically relevant effects on atherogenesis. This randomized, controlled, observer-blind, clinical, single-center trial enrolled 321 healthy postmenopausal women with increased IMT in greater than or equal to1 segment of the carotid arteries. For a period of 48 weeks, subjects received either 1 mg/d 17 beta -estradiol continuously plus 0.025 mg gestodene for 12 days every month (standard-progestin group), or 1 mg 17 beta -estradio plus 0.025 mg gestodene for 12 days every third month (low-progestin group), or no HRT. Maximum IMT in 6 carotid artery segments (common, bifurcation, and internal, both sides) was measured by B-mode ultrasound before and after intervention. HRT did not slow IMT progression in carotid arteries. Mean maximum IMT in the carotid arteries increased by 0.02'0.05 mm in the no HRT group and by 0.03 +/-0.05 and 0.03 +/-0.05 mm, respectively, in the HRT groups (P>0.2). HRT significantly decreased LDL cholesterol, fibrinogen, and follicle-stimulating hormone. In conclusion, 1 year of HRT was not effective in slowing progression of subclinical atherosclerosis in postmenopausal