Postmenopausal hormone replacement therapy and the primary prevention of cardiovascular disease
Postmenopausal hormone replacement therapy and the primary prevention of cardiovascular disease
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DOI：
10.7326/0003-4819-137-4-200208200-00012
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发表时间：
2002-08-20
影响因子：
39.2
通讯作者：
Sox, HC
中科院分区：
文献类型：
--
作者：
Humphrey, LL;Chan, BKS;Sox, HC
目的：评估激素替代疗法 (HRT) 在心血管疾病 (CVD) 和冠状动脉疾病 (CAD) 一级预防中的价值。数据来源：检索 MEDLINE 和 Cochrane 数据库，查找所有报告 CVD 或 CAD 发病率、死亡率或两者与 HRT 相关的一级预防研究；还审查了参考文献列表、信件、社论和评论。数据提取：对所有研究进行了审查、摘要和质量评级。研究选择：只有根据美国预防服务工作组 (USPSTF) 标准，质量良好或一般的研究才纳入详细审查和荟萃分析。数据合成：任何 HRT 使用的总结相对风险为 0.75（95% 可信区间 [Crl]，0.42 至CVD 死亡率为 1.23），CAD 死亡率为 0.74（Crl，0.36 至 1.45）。任何使用的总相对风险CVD发病率为1.28（Crl，0.86至2.00），CAD发病率为0.87（Crl，0.62至1.21）。对根据社会经济状况以及其他主要 CAD 风险因素进行调整的研究进行的进一步分析显示，与任何 HRT 使用相关的 CAD 发病率的总体相对风险为 1.07（Crl，0.79 至 1.48）。除了其他主要风险因素外，通过调整饮酒、运动或两者的研究进行分层分析时也发现了类似的结果，表明这些因素存在混淆。结论：本荟萃分析与之前的荟萃分析不同，它评估了 HRT、CVD 和 CAD 之间关系的潜在解释变量。调整后的荟萃分析与最近的随机试验一致，这些试验表明对 CVD 事件的二级或一级预防没有益处。 HRT 在 CVD 一级预防中的作用的有效答案最好来自随机对照试验。
Purpose: To evaluate the value of hormone replacement therapy (HRT) in the primary prevention of cardiovascular disease (CVD) and coronary artery disease (CAD).Data Sources: MEDLINE and Cochrane databases were searched for all primary prevention studies reporting CVD or CAD incidence, mortality, or both in association with HRT; reference lists, letters, editorials, and reviews were also reviewed.Data Extraction: All studies were reviewed, abstracted, and rated for quality.Study Selection: Only studies of good or fair quality, according to U.S. Preventive Services Task Force (USPSTF) criteria, were included in the detailed review and meta-analysis.Data Synthesis: The summary relative risk with any HRT use was 0.75 (95% credible interval [Crl], 0.42 to 1.23) for CVD mortality and 0.74 (Crl, 0.36 to 1.45) for CAD mortality. The summary relative risk with any use was 1.28 (Crl, 0.86 to 2.00) for CVD incidence and 0.87 (Crl, 0.62 to 1.21) for CAD incidence. Further analysis of studies adjusting for socioeconomic status, as well as other major CAD risk factors, showed a summary relative risk of 1.07 (Crl, 0.79 to 1.48) for CAD incidence associated with any HRT use. Similar results were found when the analysis was stratified by studies adjusting for alcohol consumption, exercise, or both, in addition to other major risk factors, suggesting confounding by these factors.Conclusions: This meta-analysis differs from previous meta-analyses by evaluating potential explanatory variables of the relationship between HRT, CVD, and CAD. The adjusted meta-analysis is consistent with recent randomized trials that have shown no benefit in the secondary or primary prevention of CVD events. A valid answer to the role of HRT in the primary prevention of CVD will best come from randomized, controlled trials.