Effects of hormone replacement on progression of coronary calcium as measured by electron beam tomography
Effects of hormone replacement on progression of coronary calcium as measured by electron beam tomography
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DOI：
10.1089/jwh.2005.14.410
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发表时间：
2005-06-01
影响因子：
3.5
通讯作者：
Mao, SS
中科院分区：
文献类型：
--
作者：
Budoff, MJ;Chen, GPW;Mao, SS
目的：最近的妇女健康倡议(WHI)结果表明，在没有症状的妇女中，雌激素和孕激素联合使用会使心血管风险和乳腺癌的风险增加，但幅度很小，但幅度很大。然而，非对立雌激素的效果和潜在益处还不清楚。在一项观察性研究中，我们试图使用非激素替代疗法(HRT)、联合疗法和单用雌激素来评估绝经后妇女亚临床动脉粥样硬化的进展情况。方法：在我们的中心对没有症状或已知的冠心病(CHD)的绝经后妇女进行冠状动脉钙化的随访。这些患者被内科医生推荐，并接受了至少一年间隔的连续两次电子束断层扫描。所有符合研究标准的女性都被要求参加，那些同意的女性也被包括在内。通过访谈收集了人口学数据、冠心病、激素替代疗法和其他用药的危险因素。结果：这项研究包括177名无症状女性。在接受任何激素治疗的女性(n=97)中，钙进展为14.6%+/-21%。非使用者(n=80)的年钙进展率为22.3%+/-32%。与非使用者组相比，HRT治疗将动脉粥样硬化的进展抑制了35%(p=0.01)。这种影响与年龄、风险、心血管因素、他汀类药物的使用或基线CAC评分无关。97名女性中有35名(36%)正在服用雌激素和孕激素，钙评分每年增加24%+/-23%，与非HRT女性(22%)相似。仅接受雌激素替代治疗的女性(n=62)降低了63%(9%+/-22%)。结论：这是一项观察性研究，结果与最近发表的WHI研究一致，表明雌激素+孕激素与不治疗相比没有好处。然而，与非激素替代疗法和雌激素加孕激素相比，服用非抗雌激素的女性显示出亚临床动脉粥样硬化的显著减缓。
Purpose: The recent Women's Health Initiative (WHI) results have demonstrated that combined estrogen plus progestin imparts a small but significant increase in cardiovascular risk and breast cancer among asymptomatic women. However, the effect and potential benefit of unopposed estrogen is not as clear. We sought to evaluate the progression of subclinical atherosclerosis in postmenopausal women using no hormone replacement therapy (HRT), combined therapy, and estrogen alone in an observational study.Methods: Postmenopausal women without symptoms or known coronary heart disease (CHD) were evaluated at our center for follow-up of coronary calcification. Patients were physician referred and underwent two consecutive electron beam tomography scans at least 1 year apart. All women fitting the study criteria were asked to participate, and those who consented were included. Demographic data, risk factors for CHD, HRT, and other medication use were collected by interview.Results: The study included 177 asymptomatic women. Calcium progression was 14.6% +/- 21% in women taking any hormone therapy ( n = 97). Annual calcium progression rates in nonusers ( n = 80) was 22.3% +/- 32%. Relative to the nonuser group, HRT treatment inhibited the progression of atherosclerosis by 35% ( p = 0.01). This effect was independent of age, risk, cardiovascular factors, statin use, or baseline CAC score. Thirty-five of the 97 women (36%) were taking estrogen plus progestin, with an annual increase in calcium scores of 24% +/- 23%, similar to the non-HRT women (22%). Those women taking estrogen replacement only ( n = 62) was 63% lower (9% +/- 22%).Conclusions: This is an observational study, and the results are in accordance with the recently published WHI study, demonstrating no benefit of estrogen plus progestin compared with no therapy. However, women taking unopposed estrogen demonstrated a significant slowing of subclinical atherosclerosis compared with non-HRT and estrogen plus progestin.