Hormone replacement therapy and acute myocardial infarction: a large observational study exploring the influence of age
Hormone replacement therapy and acute myocardial infarction: a large observational study exploring the influence of age
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DOI：
10.1093/ije/dyi285
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发表时间：
2006-06-01
影响因子：
7.7
通讯作者：
Pocock, S
中科院分区：
文献类型：
--
作者：
Kim, J;Evans, S;Pocock, S
背景。我们研究了激素替代疗法 (HRT) 对心肌梗死 (MI) 影响的观察性研究和随机临床试验 (RCT) 之间的差异是否可以通过参与者在开始 HRT 时或发生 MI 事件时的年龄差异来解释。方法。使用全科医学研究数据库进行了匹配的病例对照研究。 1987 年至 2001 年间首次诊断出 MI 的病例 (n = 22 225)；根据年龄、性别和实践，每个病例最多匹配六个对照（n = 144 085）。对传统心血管危险因素以及心血管药物使用和咨询率进行条件逻辑回归调整。结果。与从不使用 HRT 的患者相比，使用 HRT 的总体心肌梗死风险较低（比值比 (OR)：0.76；95% 置信区间 (95% CI) 0.68-0.86）；反对治疗（OR：0.73；95% CI 0.68-0.86）和非反对治疗（OR：0.79；95% CI 0.66-0.96）的结果相似。这种明显的益处随着开始 HRT 时年龄的增加而增加（18-44 岁：OR = 0.99；95% CI 0.74-1.33；45-54 岁：OR = 0.84；95% CI 0.71-1.00；55-64 岁：OR = 0.67；95% CI 0.54-0.82；65-74 岁：OR = 0.50；95%置信区间 0.34-0.74； > 75 岁：OR = 0.55； 95% CI 0.23-1.32）。此外，对于老年发生的心肌梗死，心脏保护作用更大（相互作用的 P 值 = 0.003）。结论。 HRT 对 MI 的影响随着开始时的年龄和 MI 事件发生时年龄的增大而变得更加明显。这些发现与观察性研究中所见的明显保护是由于年轻参与者的加入所致的假设相矛盾。
Background. We examined whether the discrepancy between observational studies and randomized clinical trials (RCTs) on the effect of hormone replacement therapy (HRT) on myocardial infarction (MI) could be explained by differences in age of participants at the time of either HRT initiation or the MI event.Methods. A matched case-control study was performed using the General Practice Research Database. Cases (n = 22 225) had a first diagnosis of MI between 1987 and 2001; up to six controls (n = 144 085) were matched to each case based on age, sex, and practice. Conditional logistic regression was performed adjusting for traditional cardiovascular risk factors, as well as, cardiovascular drug use and consultation rate.Results. HRT users had a lower overall risk of MI compared with never users (odds ratio (OR): 0.76; 95% confidence interval (95% CI) 0.68-0.86); results were similar for opposed (OR: 0.73; 95% CI 0.68-0.86) and unopposed (OR: 0.79; 95% CI 0.66-0.96) therapy. This apparent benefit increased with older age at HRT initiation(18-44 years: OR = 0.99; 95% CI 0.74-1.33; 45-54 years: OR = 0.84; 95% CI 0.71-1.00; 55-64 years: OR = 0.67; 95% CI 0.54-0.82; 65-74 years: OR = 0.50; 95% CI 0.34-0.74; > 75 years: OR = 0.55; 95% CI 0.23-1.32). Moreover, the cardioprotective effect was greater for MIs occurring at older ages (P-value for interaction = 0.003).Conclusion. The effect of HRT on MI becomes more pronounced with older age at initiation and at older ages at the time of an MI event. These findings contradict the hypothesis that the apparent protection seen in observational studies was due to the inclusion of younger participants.