Cognitive benefits of hormone therapy: cardiovascular factors and healthy-user bias.
Cognitive benefits of hormone therapy: cardiovascular factors and healthy-user bias.
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DOI：
10.1016/j.maturitas.2009.09.014
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发表时间：
2009-11-20
期刊：
影响因子：
4.9
通讯作者：
Gleason CE
中科院分区：
文献类型：
--
作者：
Wharton W;Dowling M;Khosropour CM;Carlsson C;Asthana S;Gleason CE
妇女健康倡议研究（WHI）及其辅助记忆研究（WHIMS）揭示了心血管风险，认知能力下降和痴呆症的发生率增加与反对共轭马雌激素（CEE）。因此，以前接受的观察数据表明，激素治疗（HT）对心血管和认知有益，并降低了痴呆症的风险，这在很大程度上归因于“健康用户”的偏见。目前的观察，以社区为基础的病例对照研究探讨了“健康用户”的偏见理论，通过比较认知任务的表现在两组绝经后妇女，谁是HT用户或非用户。参与者是213名居住在社区和辅助生活设施的非痴呆绝经后妇女，她们完成了自我报告的健康问卷，并进行了一小时的认知测试。为了研究变量对认知成绩预测的独立贡献，我们采用了一系列分层回归模型，在三个阶段中加入了术语。第一阶段仅包括HT，第二阶段添加人口统计学，最后一阶段添加酒精，抑郁和来自验证性因素分析的心血管危险因素（CVRF）复合因素。CVRF复合终点包括：卒中、糖尿病、高血压和高胆固醇血症。虽然独立样本t检验显示两组之间CVRF复合物及其单个组分无统计学显著差异，但HT使用者的CVRF往往少于非使用者。相反，HT使用者比非使用者更年轻，受教育程度更高。HT用户在7/9个认知变量上优于非用户。控制CVRF、人口统计学变量和情绪的完整回归模型显示，HT使用者在言语记忆和抽象推理方面优于非使用者。虽然有一些证据表明HT使用者比非使用者拥有更少的预先存在的CVRF，但观察到的HT与认知之间的正相关并不能完全解释这一趋势。
The Women's Health Initiative study (WHI) and its ancillary Memory Study (WHIMS) revealed increased rates of cardiovascular risk, cognitive decline and dementia with opposed conjugated equine estrogens (CEE). As a result, previously accepted observational data suggesting cardiovascular and cognitive benefits and reduced risk for dementia with hormone therapy (HT) were largely attributed to ‘healthy-user’ bias. The present observational, community-based, case-controlled study examined the ‘healthy-user’ bias theory by comparing cognitive task performance in two groups of postmenopausal women, who were either HT users or non-users. Participants were 213 non-demented, postmenopausal women residing in the community and in assisted-living facilities who completed a self-report health questionnaire and underwent a one hour cognitive test battery. To study the independent contribution of variables in the prediction of cognitive performance, we employed a series of hierarchical regression models adding terms in three stages. The first stage included only HT, the second stage added demographics, and the last stage added alcohol, depression and a cardiovascular risk factor (CVRF) composite derived from a confirmatory factor analysis. The CVRF composite consisted of: stroke, diabetes, hypertension, and hypercholesterolemia. Although independent samples t-tests revealed no statistically significant differences in the CVRF composite and its individual components between the two groups, HT users tended to possess fewer CVRF than non-users. Conversely, HT users were younger and more educated than non-users. HT users outperformed non-users on 7/9 cognitive variables. The full regression model controlling for CVRF, demographic variables, and mood showed HT users outperformed non-users on measures of verbal memory and abstract reasoning. While there is some evidence HT users possess fewer preexisting CVRF than non-users, the observed positive association between HT and cognition is not completely explained by this trend.
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