Menopausal Hormone Therapy and Risks of First Hospitalized Heart Failure and its Subtypes During the Intervention and Extended Postintervention Follow-up of the Women's Health Initiative Randomized Trials
Menopausal Hormone Therapy and Risks of First Hospitalized Heart Failure and its Subtypes During the Intervention and Extended Postintervention Follow-up of the Women's Health Initiative Randomized Trials
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DOI：
10.1016/j.cardfail.2019.09.006
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发表时间：
2020-01-01
影响因子：
6
通讯作者：
Manson, JoAnn E.
中科院分区：
文献类型：
--
作者：
Liu, Longjian;Klein, Liviu;Manson, JoAnn E.
背景：我们评估了绝经后激素治疗（HT）是否与心力衰竭（HF）及其亚型相关，并检查了年龄是否对这种关联有影响。方法和结果：对参加妇女健康倡议 HT 试验的 50-79 岁绝经后妇女进行了分析。 16,486 名有子宫的女性被随机分配接受结合马雌激素（CEE 0.625 毫克/天）加醋酸甲羟孕酮（MPA 2.5 毫克/天）或安慰剂，10,739 名既往接受过子宫切除术的女性被随机分配接受单独 CEE（0.625 毫克/天）或安慰剂。心力衰竭事件定义为首次心力衰竭住院治疗。射血分数降低 (HFrEF) 或射血分数保留 (HFpEF) 的 HF 定义为 EF < 50% 或 >= 50%。在干预阶段，CEE+MPA 试验的中位随访时间为 5.6 年，单独 CEE 试验的中位随访时间为 7.2 年。在 18.9 年的累积随访期间，在 2 项联合试验中随机接受 HT 与安慰剂的女性的总 HF 发病率分别为每 1000 人年 3.90 例和 3.89 例； HFrEF 分别为每 1000 人年 1.25 和 1.40，HFpEF 分别为每 1000 人年 1.88 和 1.79。在这两项试验中，HT 对心力衰竭或其亚型总发生风险没有显着影响，随机年龄也没有显着改变结果。结论：在干预期间或累计 18.9 年的随访期间，绝经后 HT 并未改变因 HF 或其亚型住院的风险，并且结果在随机分组时没有因年龄而显着变化。
Background: We assessed whether postmenopausal hormone therapy (HT) was associated with incident heart failure (HF) and its subtypes and examined whether there was a modifying effect of age on the associations. Methods and Results: Postmenopausal women aged 50-79 enrolled in the Women's Health Initiative HT trials were analyzed. The 16,486 women with a uterus were randomized to receive conjugated equine estrogens (CEE 0.625 mg/day) plus medroxyprogesterone acetate (MPA 2.5 mg/day) or placebo, and 10,739 women with prior hysterectomy were randomized to receive CEE (0.625 mg/day) alone or placebo. Incident HF was defined as the first HF hospitalization. HF with reduced ejection fraction (HFrEF) or preserved EF (HFpEF) was defined as EF < 50% or >= 50%. During the intervention phase, median follow-up was 5.6 years in the CEE-plus-MPA trial and 7.2 years in the CEE-alone trial. During the cumulative follow-up of 18.9 years, women randomized to HT vs placebo in the 2 combined trials had incidence rates of 3.90 vs 3.89 per 1000 person-years for total HF; 1.25 vs 1.40 per 1000 person-years for HFrEF, and 1.88 vs 1.79 per 1000 person-years for HFpEF, respectively. There were no significant effects of HT on the risk of total incident HF or its subtypes in either trial, and age at randomization did not significantly modify the results. Conclusions: Postmenopausal HT did not alter the risk of hospitalization for HF or its subtypes during the intervention or cumulative 18.9 years of follow-up, and results did not vary significantly by age at randomization.