Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women's Health Initiative Observational Study.
Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women's Health Initiative Observational Study.
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DOI：
10.1097/gme.0000000000000956
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发表时间：
2018-01
期刊：
影响因子：
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通讯作者：
Manson JE
中科院分区：
文献类型：
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作者：
Crandall CJ;Hovey KM;Andrews CA;Chlebowski RT;Stefanick ML;Lane DS;Shifren J;Chen C;Kaunitz AM;Cauley JA;Manson JE
为了确定阴道雌激素的使用与全球指数事件[GIE]风险之间的相关性，全球指数事件[GIE]定义为首次发生冠心病(CHD)、浸润性乳腺癌、中风、肺栓塞、髋部骨折、结直肠癌、子宫内膜癌或任何原因死亡的时间。在这项前瞻性观察队列研究中，我们使用了来自女性健康倡议观察性研究的参与者的数据，他们是在40个美国临床中心招募的，基线年龄为50-79岁，在随访期间没有使用系统雌激素治疗(n=45,663，中位随访7.2年)。我们收集了有关冠心病、浸润性乳腺癌、中风、肺栓塞、髋部骨折、结直肠癌、子宫内膜癌、死亡和自我报告的阴道雌激素(乳膏、片剂)使用情况的数据。我们使用COX比例风险回归模型对协变量进行调整。在子宫完整的女性中，使用和不使用雌激素的女性患中风、浸润性乳腺癌、结直肠癌、子宫内膜癌和肺栓塞/深静脉血栓的风险没有显著差异，而使用雌激素的女性患冠心病、骨折、全因死亡率和GIE的风险低于不使用雌激素的女性(GIE调整的风险比[AHR]0.68；95%可信区间[CI]0.55-0.86)。在切除子宫的妇女中，使用和不使用阴道雌激素的妇女的GIE各部分和整体GIE的风险没有显著差异(GIE AHR=0.94；95%CI为0.70-1.26)。在使用阴道雌激素的绝经后妇女中，心血管疾病和癌症的风险并未增加，这为治疗的安全性提供了保证。
To determine the association between use of vaginal estrogen and risk of a global index event [GIE], defined as time to first occurrence of coronary heart disease (CHD), invasive breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, or death from any cause. For this prospective observational cohort study, we used data from participants of the Women's Health Initiative Observational Study who were recruited at 40 U.S. Clinical Centers, aged 50-79 years at baseline, and did not use systemic estrogen therapy during follow-up (n = 45,663, median follow-up 7.2 years). We collected data regarding incident CHD, invasive breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, death, and self-reported use of vaginal estrogen (cream, tablet). We used Cox proportional hazards regression models to adjust for covariates. Among women with an intact uterus, the risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonary embolism/deep vein thrombosis were not significantly different between vaginal estrogen users and nonusers, while the risks of CHD, fracture, all-cause mortality, and GIE were lower in users than nonusers (GIE adjusted hazard ratio [aHR] 0.68; 95% confidence interval [CI] 0.55-0.86). Among hysterectomized women, the risks of each of the individual GIE components and of the overall GIE were not significantly different in users versus nonusers of vaginal estrogen (GIE aHR=0.94; 95% CI 0.70-1.26). The risks of cardiovascular disease and cancer were not elevated among postmenopausal women using vaginal estrogens, providing reassurance about the safety of treatment.