Estrogen and progestin use and the QT interval in postmenopausal women
Estrogen and progestin use and the QT interval in postmenopausal women
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DOI：
10.1111/j.1542-474x.2004.94580.x
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发表时间：
2004-10-01
影响因子：
1.9
通讯作者：
Schwartz, JB
中科院分区：
文献类型：
--
作者：
Kadish, AH;Greenland, P;Schwartz, JB
目的：确定绝经期激素治疗是否会改变主要健康绝经后妇女的QT间期。背景：尽管众所周知，女性心肌复极存在性别差异，包括心率校正的QT间期（QT(C)）比男性更长，但绝经期激素治疗对女性心肌复极的影响尚未得到很好的表征。方法：我们研究了34,378名参加妇女健康倡议饮食干预部分的绝经后妇女。横断面关联检验评估雌激素+孕酮对心肌复极的可能影响。报告称从未接受过更年期激素治疗的妇女（n = 12451）与过去接受过更年期激素治疗的妇女（n = 3891）、目前正在接受无对抗性雌激素治疗的妇女（n = 9987）或目前雌激素和孕激素联合治疗的妇女（n = 8049）进行比较。结果：通过协方差分析，从未接受过绝经期激素治疗的患者QT间期（+/- sem）平均为423.9 +/- 0.3毫秒（ms），既往接受过绝经期激素治疗的患者QT间期(C)平均为423.9 +/- 0.3毫秒（ms），目前仅接受雌激素治疗的患者QT间期(C)平均为425.6 +/- 0.2毫秒（ms），目前接受雌激素-孕激素联合治疗的患者QT间期平均为424.0 +/- 0.2毫秒（ms）。单独使用雌激素组与其他三组之间的平均QT(C)差异有统计学意义。各组间JT间期、QT间期和线性校正QT间期的比较结果相似。结论：绝经期妇女未拮抗雌激素可轻度延长心肌复极，而黄体酮可逆转这一作用。这些发现是否具有临床意义有待进一步研究。
Objective: To determine whether menopausal hormone therapy alters the QT interval in primarily healthy postmenopausal women.Background: Despite well-known gender differences in myocardial repolarization that include a longer heart-rate-corrected QT interval (QT(C)) in women compared to men, the effects of menopausal hormone therapy on myocardial repolarization in women have not been well characterized.Methods: We studied 34,378 postmenopausal women participating in the dietary intervention component of the Women's Health Initiative. Cross-sectional associations were examined to assess possible effects of estrogen + progesterone on myocardial repolarization. Women who reported that they were never treated with menopausal hormone therapy (n = 12,451) were compared to women with a past use of menopausal hormone therapy (n = 3891), currently taking unopposed estrogen therapy (n = 9987), or combined current estrogen and progesterone therapy (n = 8049).Results: Using analysis of covariance, the mean (+/-SEM) QT(C) interval was 423.9 +/- 0.3 milliseconds (ms) in those never treated with menopausal hormone therapy, 423.9 +/- 0.3 ms in past menopausal hormone therapy users, 425.6 +/- 0.2 ms in those currently on estrogen alone, and 424.0 +/- 0.2 ms in women currently on combined estrogen-progesterone therapy. Differences in mean QT(C) between those on estrogen alone and the other three groups were statistically significant. Comparisons of JT intervals, QT intervals, and linear corrected QT intervals among the groups yielded similar results.Conclusion: These results suggest that unopposed estrogen in menopausal women mildly prolongs myocardial repolarization, and the effect is reversed by progesterone. Whether these findings have clinical significance requires further study.