Effect of estrogen plus progestin on progression of carotid atherosclerosis in postmenopausal women with heart disease - HERS B-mode substudy
Effect of estrogen plus progestin on progression of carotid atherosclerosis in postmenopausal women with heart disease - HERS B-mode substudy
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DOI：
10.1161/01.atv.0000033514.79653.04
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发表时间：
2002-10-01
影响因子：
8.7
通讯作者：
Applegate, WB
中科院分区：
文献类型：
--
作者：
Byington, RP;Furberg, CD;Applegate, WB
目的——心脏和雌激素/孕激素替代研究 (HERS) 发现，雌激素加孕激素（与安慰剂相比）对 2763 名患有冠心病的绝经后妇女的冠心病事件发生率没有总体影响（平均随访时间为 4.1 年）。除了事件试验之外，1993 年还同时进行了一项颈动脉超声亚研究，以确定激素治疗是否影响潜在动脉粥样硬化过程的进展。 方法和结果 - 在较大的 HERS 中，362 名参与者在基线和随访结束时接受了颈动脉 B 型超声检查。颈动脉粥样硬化的进展通过内膜中层厚度 (IMT) 的时间变化来测量。结论 - IMT 在激素治疗组和安慰剂组中进展，尽管比率之间没有统计学差异：激素组中 IMT 进展 26 mum/y（95% Cl 18 至 34 mum/y），而安慰剂组中 IMT 进展 31 mum/y（95% Cl 21 至 40 mum/y）安慰剂组（P=0.44）。当通过颈动脉段检查结果或针对协变量进行调整时，也没有显着的治疗效果。这些数据支持美国心脏协会的建议，即患有冠心病的女性不应开始激素治疗以期获得动脉粥样硬化益处。
Objective-The Heart and Estrogen/Progestin Replacement Study (HERS) found no overall effect of estrogen plus progestin (compared with placebo) on coronary event rates in 2763 postmenopausal women with established coronary disease (mean 4.1 years of follow-up). In addition to the events trial, a carotid ultrasound substudy was established in 1993 to be conducted concurrently to determine whether hormone therapy affects the progression of the underlying atherosclerotic process.Methods and Results-Within the larger HERS, a subset of 362 participants underwent carotid B-mode ultrasound examinations at baseline and the end of follow-up. Progression of carotid atherosclerosis was measured as the temporal change in intimal-medial thickness (IMT).Conclusions-IMT progressed in the hormone treatment and placebo groups, although there was no statistical difference between the rates: IMT progressed 26 mum/y (95% Cl 18 to 34 mum/y) in the hormone group and 31 mum/y (95% Cl 21 to 40 mum/y) in the placebo group (P=0.44). There were also no significant treatment effects when the results were examined by carotid segment or were adjusted for covariates. These data support the American Heart Association recommendation that women with established coronary disease should not initiate hormone therapy with an expectation of atherosclerotic benefit.