Postmenopausal hormone use in women with acute coronary syndromes
Postmenopausal hormone use in women with acute coronary syndromes
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DOI：
10.1089/jwh.2004.13.863
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发表时间：
2004-10-01
影响因子：
3.5
通讯作者：
Califf, RM
中科院分区：
文献类型：
--
作者：
Parsons, E;Newby, LK;Califf, RM
背景：最近的试验表明，慢性激素替代疗法(HRT)没有好处，也可能有害。关于急性冠脉综合征(ACS)患者使用激素替代疗法(HRT)的中期结果知之甚少。方法：为了研究在急性冠脉综合征(ACS)女性患者中使用HRT的流行率及其与中期结果的关系，我们将4029名绝经后妇女(年龄50岁或绝经后病例报告表)随机分为HRT使用者和非使用者，在西布拉非班和阿司匹林试验中随机进行，以最大限度地预防急性冠脉综合征后缺血性心脏事件(SYMPHON)和第二个SYMPHONY试验。结果：HRT的总使用率为13%，且因地区而异(亚洲，0%；东欧，0.2%；拉丁美洲，0.8%；西欧，4%；澳大利亚/新西兰，12%；加拿大，14%；美国，24%)；单用雌激素方案最常见(90%)。激素替代疗法的使用者更年轻，肌酐清除量的估计值更高，吸烟者更多，曾有血管再通史，但较少有糖尿病、心绞痛或心力衰竭的病例。HRT使用者未经校正的90天和1年死亡率较低(风险比[95%CI]分别为0.48[0.23~0.98]和0.35[0.18~0.68])，但经多因素校正后，差异无统计学意义。HRT使用者和非使用者之间的90天卒中和复合终点没有差异。结论：在急性冠脉综合征患者中，HRT的使用量(主要是仅使用雌激素)较低，但因地区而异，与改善中期预后无关。这些结果与之前在更稳定的人群中进行的研究中使用HRT(联合或仅使用雌激素)没有好处的说法是一致的。
Background: Recent trials reveal no benefit and possible harm from chronic hormone replacement therapy (HRT). Less is known about intermediate-term outcomes associated with HRT use in the setting of acute coronary syndromes (ACS).Methods: To examine the prevalence of HRT use and relationships with intermediate- term outcomes among women with ACS, we classified as HRT users or nonusers 4029 postmenopausal women ( age > 50 years or postmenopausal by case report form) randomized in the Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-Acute Coronary Syndromes ( SYMPHONY) and 2nd SYMPHONY trials. Outcomes included 90-day and 1-year death and 90-day stroke, death, or myocardial infarction (MI); death, MI, or stroke; and death, MI, or severe recurrent ischemia (SRI).Results: HRT use was 13% overall and varied by region ( Asia, 0%; Eastern Europe, 0.2%; Latin America, 0.8%; Western Europe, 4%; Australia/ New Zealand, 12%; Canada, 14%; United States, 24%); estrogen-only regimens were most common (90%). HRT users were younger, had higher estimated creatinine clearance, more frequently were smokers and had prior revascularization, but less frequently had diabetes, prior angina, or heart failure. Unadjusted 90-day and 1-year mortality rates were lower among HRT users ( hazard ratios [95% CI] 0.48 [0.23-0.98] and 0.35 [0.18-0.68], respectively) but after multivariable adjustment, were not significantly different. Ninety-day stroke and composite end points did not differ between HRT users and nonusers.Conclusions: HRT use ( predominantly estrogen-only) was low among patients with ACS but varied by region and was not associated with improved intermediate- term outcomes. These results are consistent with the absence of benefit from HRT use ( combination or estrogen only) in previous studies in more stable populations.