Postmenopausal hormone therapy and mortality
Postmenopausal hormone therapy and mortality
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DOI：
10.1056/nejm199706193362501
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发表时间：
1997-06-19
影响因子：
158.5
通讯作者：
Speizer, FE
中科院分区：
文献类型：
--
作者：
Grodstein, F;Stampfer, MJ;Speizer, FE
背景绝经后激素治疗既有好处也有危害，包括降低骨质疏松症和心血管疾病的风险，增加乳腺癌的风险。方法我们研究了在1976年的护士健康研究中，年龄在30 ~ 55岁的参与者中，绝经后激素的使用与死亡率之间的关系。数据收集两年一次的问卷调查从1976年开始，一直持续到1992年。从1976年到1994年，我们记录了3637例死亡。每个死亡的参与者都与10个在她死亡时还活着的对照组相匹配。对于每例死亡，我们根据受试者死亡前或致命性疾病诊断前的最后两年一次的问卷调查来定义受试者的激素状态;这减少了在诊断出潜在致命性疾病和死亡之间停止使用激素所引起的偏倚。（相对危险度，0.63; 95%置信区间，0.56 - 0.70）;然而，长期使用激素的明显益处会减少。（相对危险度，0.80; 0.67至0.96，10年或更长时间后），因为长期使用激素的乳腺癌死亡率增加。目前有冠状动脉危险因素的激素使用者（69%的女性）死亡率下降幅度最大（相对风险，0.51; 95%置信区间，0.45至0.57），低风险患者的获益显著减少（13%的妇女;相对危险度，0.89; 95%可信区间，0.62 ~ 1.28）结论：平均而言，绝经后使用激素的妇女死亡率低于未使用者;然而，随着使用时间的延长，生存益处减少，并且对于冠心病风险较低的妇女来说，生存益处较低。（C）1997年，马萨诸塞州医学会。
Background Postmenopausal hormone therapy has both benefits and hazards, including decreased risks of osteoporosis and cardiovascular disease and an increased risk of breast cancer.Methods We examined the relation between the use of postmenopausal hormones and mortality among participants in the Nurses' Health Study, who were 30 to 55 years of age at base line in 1976. Data were collected by biennial questionnaires beginning in 1976 and continuing th rough 1992. We documented 3637 deaths from 1976 to 1994. Each participant who died was matched with 10 controls alive at the time of her death. For each death, we defined the subject's hormone status according to the last biennial questionnaire before her death or before the diagnosis of the fatal disease; this reduced bias caused by the discontinuation of hormone use between the time of diagnosis of a potentially fatal disease and death.Results After adjustment for confounding variables, current hormone users had a lower risk-of death (relative risk, 0.63; 95 percent confidence interval, 0.56 to 0.70) than subjects who had never taken hormones; however, the apparent benefit decreased with long-term use (relative risk, 0.80; 0.67 to 0.96, after 10 or more years) because of an increase in mortality from breast cancer among long-term hormone users. Current hormone users with coronary risk factors (69 percent of the women) had the largest reduction in mortality (relative risk, 0.51; 95 percent confidence interval, 0.45 to 0.57), with substantially less benefit for those at low risk (13 percent of the women; relative risk, 0.89; 95 percent confidence interval, 0.62 to 1.28).Conclusions On average, mortality among women who use postmenopausal hormones is lower than among nonusers; however, the survival benefit diminishes with longer duration of use and is lower for women at low risk for coronary disease. (C)1997, Massachusetts Medical Society.