Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the nurses' health study.
Postmenopausal estrogen therapy and cardiovascular disease. Ten-year follow-up from the nurses' health study.
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DOI：
10.1097/00006254-199202000-00027
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发表时间：
1991-09
期刊：
影响因子：
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通讯作者：
M. Stampfer;G. Colditz;W. Willett;J. Manson;B. Rosner;F. Speizer;C. Hennekens
中科院分区：
文献类型：
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作者：
M. Stampfer;G. Colditz;W. Willett;J. Manson;B. Rosner;F. Speizer;C. Hennekens
绝经后雌激素治疗对心血管疾病风险的影响仍存在争议。我们1985年发表在《华尔街日报》上的报告，基于四年的随访，表明雌激素治疗降低了冠心病的风险，但同时发表的一份来自Fragrance研究的报告表明，风险增加了。此外，关于雌激素对中风影响的研究也产生了相互矛盾的结果。方法：我们随访了48,470名绝经后妇女，年龄在30到63岁之间，她们是护士健康研究的参与者，基线时没有癌症或心血管疾病史。在长达10年的随访（337,854人-年）中，我们记录了224例中风，405例严重冠心病（非致命性心肌梗死或冠状动脉原因死亡），1263例全因死亡。调整年龄和其他危险因素后，目前服用雌激素的女性患主要冠状动脉疾病的总体相对危险度为0.56（95%置信区间为0.40 ~ 0.80）;自然绝经或手术绝经的女性患主要冠状动脉疾病的风险显著降低。我们观察到雌激素使用的持续时间与年龄无关。在仅限于最近看过医生的妇女的分析中，（相对危险度，0.45; 95%可信区间，0.31 - 0.66）和低风险组，排除了报告目前吸烟、糖尿病、高血压、高胆固醇血症或克托莱指数高于第90百分位数的女性。（相对风险，0.53; 95%置信区间，0.31至0.91）。目前和以前使用雌激素的人与从未使用过雌激素的人相比，总死亡率的相对风险为0.89（95%置信区间，0.78至1.00），心血管疾病死亡率的相对风险为0.72（95%置信区间，0.55至0.95）。目前使用雌激素的人与从未使用过雌激素的人相比，中风的相对风险为0.97（95%置信区间为0.65 - 1.45），根据中风类型没有显著差异。结论：目前雌激素的使用与冠心病发病率和心血管疾病死亡率的降低有关，但与卒中风险的任何变化无关。
BACKGROUND The effect of postmenopausal estrogen therapy on the risk of cardiovascular disease remains controversial. Our 1985 report in the Journal, based on four years of follow-up, suggested that estrogen therapy reduced the risk of coronary heart disease, but a report published simultaneously from the Framingham Study suggested that the risk was increased. In addition, studies of the effect of estrogens on stroke have yielded conflicting results. METHODS We followed 48,470 postmenopausal women, 30 to 63 years old, who were participants in the Nurses' Health Study, and who did not have a history of cancer or cardiovascular disease at base line. During up to 10 years of follow-up (337,854 person-years), we documented 224 strokes, 405 cases of major coronary disease (nonfatal myocardial infarctions or deaths from coronary causes), and 1263 deaths from all causes. RESULTS After adjustment for age and other risk factors, the overall relative risk of major coronary disease in women currently taking estrogen was 0.56 (95 percent confidence interval, 0.40 to 0.80); the risk was significantly reduced among women with either natural or surgical menopause. We observed no effect of the duration of estrogen use independent of age. The findings were similar in analyses limited to women who had recently visited their physicians (relative risk, 0.45; 95 percent confidence interval, 0.31 to 0.66) and in a low-risk group that excluded women reporting current cigarette smoking, diabetes, hypertension, hypercholesterolemia, or a Quetelet index above the 90th percentile (relative risk, 0.53; 95 percent confidence interval, 0.31 to 0.91). The relative risk for current and former users of estrogen as compared with those who had never used it was 0.89 (95 percent confidence interval, 0.78 to 1.00) for total mortality and 0.72 (95 percent confidence interval, 0.55 to 0.95) for mortality from cardiovascular disease. The relative risk of stroke when current users were compared with those who had never used estrogen was 0.97 (95 percent confidence interval, 0.65 to 1.45), with no marked differences according to type of stroke. CONCLUSIONS Current estrogen use is associated with a reduction in the incidence of coronary heart disease as well as in mortality from cardiovascular disease, but it is not associated with any change in the risk of stroke.