Patient-specific decisions about hormone replacement therapy in postmenopausal women
Patient-specific decisions about hormone replacement therapy in postmenopausal women
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DOI：
10.1001/jama.277.14.1140
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发表时间：
1997-04-09
影响因子：
120.7
通讯作者：
Wong, JB
中科院分区：
文献类型：
--
作者：
Col, NF;Eckman, MH;Wong, JB
客观。-研究激素替代疗法对绝经后妇女预期寿命的影响，这些妇女具有心脏病、乳腺癌和髋关节炎的不同风险特征。使用马尔可夫模型进行决策分析，使用已发表的回归模型将风险因素与疾病发生率联系起来，并估计发生冠心病（CHD），乳腺癌，髋部骨折和子宫内膜癌的终生风险，激素治疗对疾病发生率的影响是根据已发表的流行病学研究估计的。数学模型适用于初级保健，干预。激素替代治疗或不激素替代治疗。主要结果测量。预期寿命。结果。-激素替代疗法应该增加几乎所有绝经后妇女的预期寿命，其中一些增益超过3年，主要取决于个体的CHD和乳腺癌的风险因素，对于至少有1个CHD风险因素的妇女，激素疗法应该延长预期寿命，即使是一级亲属患有乳腺癌的妇女，没有CHD或髋部骨折的任何风险因素的妇女，但是，有2个一级亲属患有乳腺癌的人，不应该接受激素治疗。对于几乎所有可能考虑使用激素替代疗法的女性来说，激素替代疗法在降低患CHD的可能性方面的益处似乎超过了患乳腺癌的风险，我们的分析支持更广泛地使用激素替代疗法。
Objective.-To examine the effect of hormone replacement therapy on life expectancy in postmenopausal women with different risk profiles for heart disease, breast cancer, and hip fracture.Design.-Decision analysis using a Markov model, Published regression models were used to link risk factors to disease incidence and to estimate the lifetime risks of developing coronary heart disease (CHD), breast cancer, hip fracture, and endometrial cancer, The impact of hormone therapy on disease incidence was estimated from published epidemiologic studies.Setting.-Mathematical model applicable to primary care,Interventions.-Treatment with hormone replacement therapy or no hormone replacement therapy.Main Outcome Measure.-Life expectancy.Results.-Hormone replacement therapy should increase life expectancy for nearly all postmenopausal women, with some gains exceeding 3 years, depending mainly on an individual's risk factors for CHD and breast cancer, For women with at least 1 risk factor for CHD, hormone therapy should extend life expectancy, even for women having first-degree relatives with breast cancer, Women without any risk factors for CHD or hip fracture, but who have 2 first-degree relatives with breast cancer, however, should not receive hormone therapy.Conclusions.-The benefit of hormone replacement therapy in reducing the likelihood of developing CHD appears to outweigh the risk of breast cancer for nearly all women in whom this treatment might be considered, Our analysis supports the broader use of hormone replacement therapy.