POSTMENOPAUSAL ESTROGEN THERAPY AND CARDIOVASCULAR-DISEASE - 10-YEAR FOLLOW-UP FROM THE NURSES HEALTH STUDY
POSTMENOPAUSAL ESTROGEN THERAPY AND CARDIOVASCULAR-DISEASE - 10-YEAR FOLLOW-UP FROM THE NURSES HEALTH STUDY
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DOI：
10.1056/nejm199109123251102
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发表时间：
1991-09-12
影响因子：
158.5
通讯作者：
HENNEKENS, CH
中科院分区：
文献类型：
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作者：
STAMPFER, MJ;COLDITZ, GA;HENNEKENS, CH
背景。绝经后雌激素治疗对心血管疾病风险的影响仍存在争议。我们 1985 年在《杂志》上发表的报告基于四年的随访，表明雌激素治疗可降低冠心病的风险，但弗雷明汉研究同时发表的一份报告表明风险增加。此外，关于雌激素对中风影响的研究也得出了相互矛盾的结果。方法。我们跟踪了 48,470 名 30 至 63 岁的绝经后女性，她们是护士健康研究的参与者，并且基线时没有癌症或心血管疾病史。在长达 10 年的随访期间（337,854 人年），我们记录了 224 例中风、405 例重大冠心病（非致命性心肌梗塞或冠心病死亡）以及 1263 例各种原因导致的死亡。结果。调整年龄和其他危险因素后，目前服用雌激素的女性患主要冠心病的总体相对风险为 0.56（95% 置信区间，0.40 至 0.80）；自然绝经或手术绝经的女性的风险显着降低。我们观察到雌激素使用时间的影响与年龄无关。在仅限于最近看过医生的女性（相对风险为 0.45；95% 置信区间为 0.31 至 0.66）的分析对象中，以及排除报告当前吸烟、糖尿病、高血压、高胆固醇血症或 Quetelet 指数高于 90% 的女性的低风险组（相对风险为 0.53；95% 置信区间为 0.31 至 0.66）中，结果相似。 0.91）。与从未使用过雌激素的人相比，当前和以前使用雌激素的人的总死亡率相对风险为 0.89（95% 置信区间，0.78 至 1.00），心血管疾病死亡率为 0.72（95% 置信区间，0.55 至 0.95）。当前使用者与从未使用过雌激素的使用者相比，中风的相对风险为 0.97（95% 置信区间，0.65 至 1.45），根据中风类型没有显着差异。结论。目前雌激素的使用与冠心病发病率以及心血管疾病死亡率的降低有关，但与中风风险的任何变化无关。
Background. The effect of postmenopausal estrogen therapy on the risk of cardiovascular disease remains controversial. Our 1985 report in the Journal, based on four years of follow-up, suggested that estrogen therapy reduced the risk of coronary heart disease, but a report published simultaneously from the Framingham Study suggested that the risk was increased. In addition, studies of the effect of estrogens on stroke have yielded conflicting results.Methods. We followed 48,470 postmenopausal women, 30 to 63 years old, who were participants in the Nurses' Health Study and who did not have a history of cancer or cardiovascular disease at base line. During up to 10 years of follow-up (337,854 person-years), we documented 224 strokes, 405 cases of major coronary disease (nonfatal myocardial infarctions or deaths from coronary causes), and 1263 deaths from all causes.Results. After adjustment for age and other risk factors, the overall relative risk of major coronary disease in women currently taking estrogen was 0.56 (95 percent confidence interval, 0.40 to 0.80); the risk was significantly reduced among women with either natural or surgical menopause. We observed no effect of the duration of estrogen use independent of age. The findings were similar in analyese limited to women who had recently visited their physicians (relative risk, 0.45; 95 percent confidence interval, 0.31 to 0.66) and in a low-risk group that excluded women reporting current cigarette smoking, diabetes, hypertension, hypercholesterolemia, or a Quetelet index above the 90th percentile (relative risk, 0.53; 95 percent confidence interval, 0.31 to 0.91). The relative risk for current and former users of estrogen as compared with those who had never used it was 0.89 (95 percent confidence interval, 0.78 to 1.00) for total mortality and 0.72 (95 percent confidence interval, 0.55 to 0.95) for mortality from cardiovascular disease. The relative risk of stroke when current users were compared with those who had never used estrogen was 0.97 (95 percent confidence interval, 0.65 to 1.45), with no marked differences according to type of stroke.Conclusions. Current estrogen use is associated with a reduction in the incidence of coronary heart disease as well as in mortality from cardiovascular disease, but it is not associated with any change in the risk of stroke.