Connelly P W, Stachenko S, MacLean D R, Petrasovits A, Little J A
St Michael's Hospital and University of Toronto, Toronto, Canada.
Can J Cardiol. 1999 Apr;15(4):419-27.
To report the prevalence of lipid and nonlipid coronary artery disease risk factors in women classified by use of oral contraceptives or sex hormone replacement therapy.
DESIGN, SETTING AND PARTICIPANTS: A population-based cross-sectional survey in nine Canadian provinces (not including Nova Scotia) between 1988 and 1992 invited 13,506 women aged 18 to 74 years to participate. During a clinic visit after a home interview, a blood sample was obtained following a fast of 8 h or more from 8637 women.
Fasting plasma total cholesterol, triglycerides, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, blood pressure, smoking status, self-reported diabetes, and self-reported use of oral contraceptive or sex hormone replacement therapy pills.
The prevalence of oral contraceptive use was 41% for women 18 to 24 years old and 20% for women 25 to 34 years old. The prevalence of sex hormone replacement therapy was 4% for women 35 to 44 years old, 20% for women 45 to 64 years old and 11% for women 65 to 74 years old. Users of sex hormone replacement therapy aged 35 to 44 years had slightly higher mean LDL cholesterol than nonusers (3.04 versus 2.89 mmol/L). Users and nonusers aged 45 to 54 years had similar LDL cholesterol levels, and users aged 55 to 64 and 65 to 74 years had lower LDL cholesterol and higher HDL cholesterol levels, respectively, than nonusers. Triglyceride levels were higher in oral contraceptive users and in younger women on sex hormone replacement therapy than in nonusers. In the general population of Canada the use of oral contraceptives in women less than age 35 years had only a marginal effect on the prevalence of lipid and nonlipid risk factors. Women aged 18 to 24 years using oral contraceptives had a higher mean LDL cholesterol level of 2.73 versus 2.35 mmol/L for nonusers. The prevalence of lipid and nonlipid risk factors in women using sex hormone replacement therapy increased slightly for those aged 35 to 54 years and decreased in women aged 55 to 74 years. A lower percentage of women using sex hormone replacement therapy, aged 55 to 74 years, had high risk LDL cholesterol levels (21% versus 36% for nonusers). A larger percentage of women using sex hormone replacement therapy had low risk HDL cholesterol levels (54% versus 29% for nonusers). The nonlipid risk factor profile for women aged 35 to 54 years on sex hormone replacement therapy was less favourable than for nonusers: obesity was more common (36% versus 28%, respectively), hypertension was higher (22% versus 12%, respectively), and the proportion of women with one or more nonlipid risk factors was higher. The nonlipid risk factor profile for women 55 to 74 years of age who were using sex hormone replacement therapy was more favourable than for nonusers: obesity was lower (31% versus 47%, respectively), smoking was lower (7% versus 16%, respectively), sedentary behaviour was lower (28% versus 37%, respectively), and fewer women had two or more of these risk factors (31% versus 52%, respectively).
The findings suggest that women at higher risk for coronary artery disease tend to have a lower prevalence of use of sex hormone replacement therapy.
报告根据口服避孕药或性激素替代疗法的使用情况分类的女性中脂质和非脂质冠状动脉疾病危险因素的患病率。
设计、设置和参与者：1988年至1992年在加拿大九个省（不包括新斯科舍省）进行的一项基于人群的横断面调查邀请了13506名年龄在18至74岁之间的女性参与。在进行家庭访谈后的门诊就诊期间，从8637名女性中获取了一份在禁食8小时或更长时间后的血样。
空腹血浆总胆固醇、甘油三酯、低密度脂蛋白（LDL）胆固醇、高密度脂蛋白（HDL）胆固醇、血压、吸烟状况、自我报告的糖尿病以及自我报告的口服避孕药或性激素替代疗法药物的使用情况。
18至24岁女性口服避孕药的使用率为41%，25至34岁女性为20%。35至44岁女性性激素替代疗法的使用率为4%，45至64岁女性为20%，65至74岁女性为11%。35至44岁使用性激素替代疗法的女性平均LDL胆固醇略高于未使用者（3.04对2.89 mmol/L）。45至54岁的使用者和未使用者LDL胆固醇水平相似，55至64岁和65至74岁的使用者LDL胆固醇水平分别低于未使用者，HDL胆固醇水平高于未使用者。口服避孕药使用者以及较年轻的使用性激素替代疗法的女性甘油三酯水平高于未使用者。在加拿大普通人群中，35岁以下女性使用口服避孕药对脂质和非脂质危险因素患病率的影响很小。18至24岁使用口服避孕药的女性平均LDL胆固醇水平较高，为2.73 mmol/L，未使用者为2.35 mmol/L。35至54岁使用性激素替代疗法的女性中脂质和非脂质危险因素的患病率略有上升，55至74岁女性则下降。55至74岁使用性激素替代疗法的女性中高风险LDL胆固醇水平的比例较低（21%对未使用者的36%）。使用性激素替代疗法的女性中低风险HDL胆固醇水平的比例较高（54%对未使用者的29%）。35至54岁使用性激素替代疗法的女性的非脂质危险因素状况比未使用者更不利：肥胖更常见（分别为36%对28%），高血压更高（分别为22%对12%），有一个或多个非脂质危险因素的女性比例更高。55至74岁使用性激素替代疗法的女性的非脂质危险因素状况比未使用者更有利：肥胖更低（分别为31%对47%），吸烟更低（分别为7%对16%），久坐行为更低（分别为28%对37%），有两种或更多这些危险因素的女性更少（分别为31%对52%）。
研究结果表明，冠状动脉疾病风险较高的女性性激素替代疗法的使用率往往较低。
