MENOPAUSE AND THE RISK OF CORONARY HEART-DISEASE IN WOMEN
MENOPAUSE AND THE RISK OF CORONARY HEART-DISEASE IN WOMEN
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DOI：
10.1056/nejm198704303161801
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发表时间：
1987-04-30
影响因子：
158.5
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
--
作者：
COLDITZ, GA;WILLETT, WC;HENNEKENS, CH
为了确定绝经期与冠心病风险的关系，我们分析了1976年至1982年随访的121,700名30至55岁的美国女性的前瞻性队列数据。1976年获得了有关更年期状况、更年期类型和其他危险因素的信息，每两年通过邮寄问卷更新一次。到1982年，死亡率的随访率为98.3%，非致命性事件的随访率为95.4%。在我们控制了年龄和吸烟的因素后，与绝经期妇女相比，自然绝经和从未服用过雌激素替代疗法的妇女患冠心病的风险没有明显增加（调整后的比率比为1.2；95%置信限为0.8和1.8）。再次与绝经前妇女相比，自然绝经和使用雌激素对风险没有影响（比率比，0.8,95%置信限，0.4和1.3）。接受过双侧卵巢切除术和绝经后从未服用过雌激素的妇女的风险增加（比率比，2.2；95%置信限，1.2和4.2）。然而，与绝经前妇女相比，绝经后使用雌激素似乎消除了这些妇女增加的风险（比率比，0.9；96%置信限，0.6和1.6）。这些数据表明，与自然绝经相比，双侧卵巢切除术增加了患冠心病的风险。这种增加似乎可以通过雌激素替代疗法加以预防。
To determine the relation of menopause to the risk of coronary heart disease, we analyzed data on a prospective cohort of 121,700 U.S. women 30 to 55 years old who were followed from 1976 to 1982. Information on menopausal status, the type of menopause, and other risk factors was obtained in 1976 and updated every two years by mailing questionnaires. Through 1982, the follow-up rate was 98.3 percent for mortality and 95.4 percent for nonfatal events. After we controlled for age and cigarette smoking, women who had had a natural menopause and who had never taken replacement estrogen had no appreciable increase in the risk of coronary heart disese, as compared with permenopausal women (adjusted rate ratio, 1.2; 95 percent confidence limits, 0.8 and 1.8). Again compared with premenopausal women, the occurrence of a natural menopause together with the use of estrogens did not affect the risk (rate ratio, 0.8, 95 percent confidence limits, 0.4 and 1.3). Women who had undergone bilateral oophorectomy and who had never taken estrogens after menopause had an increased risk (rate ratio, 2.2; 95 percent confidence limits, 1.2 and 4.2). However, the use of estrogens in the postmenopausal period appeared to eliminate this increased risk among these women as compared with premenopausal women (rate ratio, 0.9; 96 percent confidence limits, 0.6 and 1.6). These data suggest that, in contrast to a natural menopause, bilateral oophorectomy increases the risk of coronary heart disease. This increase appears to be prevented by estrogen-replacement therapy.