Esterified estrogen and conjugated equine estrogen and the risk of incident myocardial infarction and stroke.
Esterified estrogen and conjugated equine estrogen and the risk of incident myocardial infarction and stroke.
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DOI：
10.1001/archinte.166.4.399
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发表时间：
2006-02
影响因子：
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通讯作者：
R. Lemaitre;N. Weiss;N. Smith;B. Psaty;T. Lumley;E. Larson;S. Heckbert
中科院分区：
文献类型：
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作者：
R. Lemaitre;N. Weiss;N. Smith;B. Psaty;T. Lumley;E. Larson;S. Heckbert
在绝经后妇女中进行的结合马雌激素（CEE）或雌二醇与安慰剂的临床试验发现，心肌梗死（MI）和中风的风险增加或无影响。这些终点与使用酯化雌激素（EE）的关联尚不清楚。方法：我们在一个健康维护组织中进行了一项基于人群的病例对照研究，检查了与当前使用CEE、使用EE或不使用激素相关的MI和卒中风险。病例均为发生MI（n = 1644）或卒中（n = 1080）的绝经后女性。对照组（n = 4205）包括无MI或卒中的绝经后妇女的随机样本。使用计算机化药房数据库评估绝经后激素的当前使用情况。结果：与未使用或使用CEE与EE相比，目前使用CEE或EE与EE相关的MI或卒中风险无差异。在仅限于激素使用者的分析中，提示单独使用CEE（不含维生素E）与单独使用EE相比，缺血性卒中风险更高（比值比，1.57; 95%置信区间，0.98-2.53）。还有一种观点认为，当在过去6个月内开始时，CEE与MI的风险高于EE相关（比值比，2.33; 95%置信区间，0.93-5.82）。结论EE对心血管终点风险的影响值得进一步研究。
BACKGROUND Clinical trials of conjugated equine estrogen (CEE) or estradiol vs placebo in postmenopausal women have found no effect or an elevated risk of myocardial infarction (MI) and stroke. The association of these end points with the use of esterified estrogen (EE) is unknown. METHODS We examined the risk of MI and stroke associated with current use of CEE, use of EE, or nonuse of hormones in a population-based case-control study in a health maintenance organization. Cases were all postmenopausal women with an incident MI (n = 1644) or stroke (n = 1080). Controls (n = 4205) consisted of a random sample of postmenopausal women without MI or stroke. Current use of postmenopausal hormones was assessed using a computerized pharmacy database. RESULTS There was no difference in risk of MI or stroke associated with current use of CEE or EE compared with nonuse or for current use of CEE compared with EE. In analyses restricted to hormone users, there was a suggestion of higher ischemic stroke risk associated with CEE alone (without progestin) compared with EE alone (odds ratio, 1.57; 95% confidence interval, 0.98-2.53). There was also a suggestion that when initiated in the previous 6 months, CEE was associated with a higher risk of MI than EE (odds ratio, 2.33; 95% confidence interval, 0.93-5.82). CONCLUSION Further study may be warranted of the effects of EE on the risk of cardiovascular end points.