Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study.
Increased longevity in older users of postmenopausal estrogen therapy: the Leisure World Cohort Study.
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绝经后雌激素治疗老年使用者的寿命延长：休闲世界队列研究。
DOI：
10.1097/01.gme.0000172880.40831.3b
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发表时间：
2006
期刊：
影响因子：
--
通讯作者：
Kawas,ClaudiaH
中科院分区：
文献类型：
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作者：
Paganini-Hill,Annlia;Corrada,MariaM;Kawas,ClaudiaH
目的：探讨绝经后雌激素治疗 (ET) 对老年女性全因死亡率的影响，包括使用时间和近期使用情况。 设计：作为 20 世纪 80 年代初开始的加州退休社区居民前瞻性队列研究的一部分，休闲世界队列女性（中位年龄 73 岁）完成了一项邮政健康调查，包括 ET 使用的详细信息，并进行了 22 年的随访（1981-2003）。使用比例风险回归计算年龄和多变量调整风险比 (RR) 和 95% CI。 结果：在 8,801 名女性中，6,626 人在随访期间死亡（中位年龄为 88 岁）。 ET 使用者的年龄调整死亡率为每 1000 人年 52.9 例，而终生不使用者的死亡率为 56.5 例（RR = 0.91；95% CI，0.87-0.96）。死亡风险随着 ET 持续时间的增加和自上次使用以来年数的减少而降低（趋势 P<0.001）。长期（≥ 15 岁）使用者的风险最低（15-19 岁的 RR= 0.83；95% CI，0.74-0.93；201 岁的 RR= 0.87；95% CI，0.80-0.94）。对于长期使用者，年龄调整死亡率为每 1000 人年 50.4 人。低剂量使用者（≤ 0.625 mg）的生存率略高于高剂量使用者（RR= 0.84；95% CI，0.78-0.91 vs RR= 0.91；95% CI，0.83-0.97）。风险因给药途径而异（P=0.56）。对潜在混杂因素的进一步调整对观察到的 ET RR 影响不大。结论：长期 ET 与老年女性较低的全因死亡率相关。最近的临床试验结果引起了人们对绝经后雌激素治疗 (ET) 长期影响的担忧。两项联合激素治疗的随机试验报告称，接受结合马雌激素加醋酸甲羟孕酮治疗组的女性患冠心病、中风和静脉血栓栓塞性疾病的风险增加。 1, 2 最近，妇女健康倡议 (WHI) 对无对抗雌激素的试验在发现风险超过收益后终止。 3 然而，这些研究无法回答有关长期使用的问题，而且不太可能进行涉及大量女性并随访 15 年或以上的随机试验。
Objective:To examine the effect of postmenopausal estrogen therapy (ET), including duration and recency of use, on all-cause mortality in older women.Design:As part of a prospective cohort study of residents of a California retirement community begun in the early 1980s, Leisure World Cohort women (median age, 73 y) completed a postal health survey including details on ET use and were followed up for 22 years (1981-2003). Age-and multivariate-adjusted risk ratios (RR) and 95% CIs were calculated using proportional hazard regression.Results:Of the 8,801 women, 6,626 died during follow-up (median age, 88 y). ET users had an age-adjusted mortality rate of 52.9 per 1,000 person-years compared with 56.5 among lifetime nonusers (RR= 0.91; 95% CI, 0.87-0.96). Risk of death decreased with both increasing duration of ET and decreasing years since last use (P for trend< 0.001). The risk was lowest among long-term (≥ 15 y) users (RR= 0.83; 95% CI, 0.74-0.93 for 15-19 y and RR= 0.87; 95% CI, 0.80-0.94 for 201 y). For long-term users, the age-adjusted mortality rate was 50.4 per 1,000 person-years. Lower-dose users (≤ 0.625 mg) had a slightly better survival rate than higher-dose users (RR= 0.84; 95% CI, 0.78-0.91 vs RR= 0.91; 95% CI, 0.83-0.97). Risk did not differ by route of administration (P= 0.56). Further adjustment for potential confounders had little effect on the observed RRs for ET.Conclusion:Long-term ET is associated with lower all-cause mortality in older women.Results of recent clinical trials have raised concern about the long-term effects of postmenopausal estrogen therapy (ET). Two randomized trials of combined hormone therapy reported increased risk of coronary heart disease, stroke, and venous thromboembolic disease among women in the group assigned to conjugated equine estrogens plus medroxyprogesterone acetate. 1, 2 Most recently, the Women's Health Initiative (WHI) trial of unopposed estrogen was terminated after finding that the risks exceeded benefits. 3 However, these studies were unable to answer questions regarding long-term use, and it is unlikely that randomized trials involving large numbers of women with follow-up of 15 or more years will be conducted.