The association of hormone replacement therapy and coronary calcium as determined by electron beam tomography.
The association of hormone replacement therapy and coronary calcium as determined by electron beam tomography.
复制标题
通过电子束断层扫描确定激素替代疗法与冠状动脉钙的关联。
DOI：
10.1089/152460902760360577
复制
发表时间：
2002
期刊：
影响因子：
--
通讯作者：
Lewin,Howard
中科院分区：
文献类型：
--
作者：
Schisterman,EnriqueF;Gallagher,AmyM;BaireyMerz,CNoel;Whitcomb,BrianW;Faraggi,David;Moysich,KristenB;Lewin,Howard
背景：观察性研究表明激素替代疗法（HRT）与低冠状动脉心脏病（CHD）相关，动物研究表明雌激素具有有效的抗动脉粥样硬化作用。矛盾的是，最近的临床试验并没有证明它有保护作用。这种矛盾可以用健康女性效应偏见来解释。使用激素替代疗法的女性改善了与潜在动脉粥样硬化负担无关的健康结果。检查冠状动脉钙化（CC）（动脉粥样硬化斑块负荷的标志）与绝经后妇女使用激素替代疗法之间的关系可能有助于解决这一矛盾。方法：研究人群包括641名无症状绝经后妇女，其中425名（66%）正在接受激素替代疗法。从自我管理问卷和血液样本中获得的数据进行了分析。对每位受试者进行了CC的电子束断层扫描（EBT）。采用方差分析（ANOVA）评价调整后的均值。结果：独立试验发现HRT组与非HRT组年龄、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）、体重指数（BMI）、维生素使用、冠状动脉钙评分（CCS）、冠状动脉钙化体积（CCV）、冠状动脉钙病变数（CCL）差异有统计学意义。然而，在控制了潜在的混杂因素后，HRT组和非HRT组在CCS、CCV或CCL数量方面没有观察到显著差异。BMI分层显示，与未接受HRT的肥胖/超重女性相比，接受HRT的肥胖/超重女性调整后的CCS和CCL更低。结论：这些发现表明，在调整了可测量的混杂因素后，绝经后妇女使用HRT与CCS、CCV和CCL之间没有关联。我们未能证明HRT使用与动脉粥样硬化斑块负荷标志物之间的独立关联，这表明在观察性研究中，健康女性效应可以解释HRT使用与冠心病之间的有益关联。
Background:Observational studies have shown that hormone replacement therapy (HRT) is associated with lower coronary heart disease (CHD), and animal studies demonstrate potent antiatherosclerotic estrogen effects. Paradoxically, recent clinical trials have not demonstrated a protective effect. This paradox may be explained by a healthy woman effect bias. Women using HRT have improved health outcomes unrelated to underlying atherosclerotic burden. Examination of the association between coronary calcium (CC), a marker of atherosclerotic plaque burden, and the use of HRT in postmenopausal women may help address this paradox.Methods:The study population comprised 641 asymptomatic postmenopausal women, 425 (66%) of whom were taking HRT. Data obtained from a self-administered questionnaire and blood samples were analyzed. Electron beam tomography (EBT) for CC was performed on each subject. Analysis of variance (ANOVA) was used to evaluate adjusted means.Results:Independentttests found that age, low-density lipoproteins (LDL), high-density lipoproteins (HDL), body mass index (BMI), vitamin use, coronary calcium score (CCS), coronary calcified volume (CCV), and the number of coronary calcium lesions (CCL) were significantly different between the HRT group and the non-HRT group. However, after controlling for potential confounders, no significant differences were observed in CCS, CCV, or the number of CCL between the HRT and non-HRT groups. Stratifying by BMI shows that obese/overweight women taking HRT have lower adjusted CCS and fewer CCL than the obese/overweight women not taking HRT.Conclusions:These findings demonstrate no association between HRT use and CCS, CCV, and CCL after adjusting for measurable confounders in postmenopausal women. Our failure to demonstrate an independent association between HRT use and a marker of atherosclerotic plaque burden suggests that a healthy woman effect may explain the beneficial association between HRT use and CHD in observational studies.