Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women.
Hormone therapy and the progression of coronary-artery atherosclerosis in postmenopausal women.
复制标题
DOI：
10.1016/j.accreview.2003.09.014
复制
发表时间：
2003-11
期刊：
影响因子：
--
通讯作者：
H. Hodis;W. Mack;S. Azen;R. Lobo;D. Shoupe;P. Mahrer;D. Faxon;L. Cashin-Hemphill;M. Sanmarco;W. French;T. Shook;T. Gaarder;A. Mehra;Ramin Rabbani;A. Sevanian;A. B. Shil;M. Torres;K. Vogelbach;R. Selzer
中科院分区：
文献类型：
--
作者：
H. Hodis;W. Mack;S. Azen;R. Lobo;D. Shoupe;P. Mahrer;D. Faxon;L. Cashin-Hemphill;M. Sanmarco;W. French;T. Shook;T. Gaarder;A. Mehra;Ramin Rabbani;A. Sevanian;A. B. Shil;M. Torres;K. Vogelbach;R. Selzer
在患有冠心病的绝经后妇女中，结合雌激素加或不加用醋酸甲羟孕酮均不能减缓动脉粥样硬化的进展。目前尚不清楚17β-雌二醇(内源性雌激素分子)单独或与醋酸甲羟孕酮顺序给药是否能延缓动脉粥样硬化的进展。方法我们对226名绝经后女性(平均年龄63.5岁)进行了一项双盲安慰剂对照试验，她们至少有一条冠状动脉病变。参与者被随机分配到常规护理组(对照组)、单独使用微粉化17β-雌二醇组(雌激素组)或17β-雌二醇加顺序注射醋酸甲羟孕酮(雌孕素组)。在所有患者中，低密度脂蛋白(LDL)胆固醇水平降至每分升低于130毫克的目标。结果经过平均3.3年的随访期，169名冠状动脉造影者的平均狭窄百分率变化(±SE)分别为对照组1.89±0.78个百分点，雌激素组2.18±0.76个百分点，雌孕素组1.24±0.80个百分点(P=0.66)。雌激素组和对照组之间的平均狭窄百分比差异为0.29个百分点(95%可信区间为-1.88~2.46)，雌孕素组和对照组之间的平均狭窄百分比差异为-0.65(95%可信区间为-2.87~1.57)。结论在已有冠状动脉粥样硬化的老年绝经后妇女中，单独使用17β-雌二醇或联合应用醋酸甲孕酮对动脉粥样硬化的进展没有显著影响。
BackgroundIn postmenopausal women with coronary artery disease, conjugated equine estrogen with or without continuous administration of medroxyprogesterone acetate has failed to slow the progression of atherosclerosis. Whether 17β-estradiol (the endogenous estrogen molecule) alone or administered sequentially with medroxyprogesterone acetate can slow the progression of atherosclerosis is unknown.MethodsWe conducted a double-blind, placebo-controlled trial in 226 postmenopausal women (mean age, 63.5 years) who had at least one coronary-artery lesion. Participants were randomly assigned to usual care (control group), estrogen therapy with micronized 17β-estradiol alone (estrogen group), or 17β-estradiol plus sequentially administered medroxyprogesterone acetate (estrogen–progestin group). In all patients the low-density lipoprotein (LDL) cholesterol level was reduced to a target of less than 130 mg per deciliter. The primary outcome was the average per-participant change between base-line and follow-up coronary angiograms in the percent stenosis measured by quantitative coronary angiography.ResultsAfter a median of 3.3 years of follow-up, the mean (±SE) change in the percent stenosis in the 169 participants who had a pair of matched angiograms was 1.89±0.78 percentage points in the control group, 2.18±0.76 in the estrogen group, and 1.24±0.80 in the estrogen–progestin group (P=0.66 for the comparison among the three groups). The mean difference in the percent stenosis between the estrogen group and the control group was 0.29 percentage point (95 percent confidence interval, –1.88 to 2.46), and the mean difference between the estrogen–progestin group and the control group was –0.65 (95 percent confidence interval, –2.87 to 1.57).ConclusionsIn older postmenopausal women with established coronary-artery atherosclerosis, 17β-estradiol either alone or with sequentially administered medroxyprogesterone acetate had no significant effect on the progression of atherosclerosis.