Alexander K P, Newby L K, Hellkamp A S, Harrington R A, Peterson E D, Kopecky S, Langer A, O'Gara P, O'Connor C M, Daly R N, Califf R M, Khan S, Fuster V
Outcomes Research and Assessment Group, The Duke Clinical Research Institute, Durham, North Carolina 27710, USA.
J Am Coll Cardiol. 2001 Jul;38(1):1-7. doi: 10.1016/s0735-1097(01)01329-8.
This study explored the association between the initiation of hormone replacement therapy (HRT) and early cardiac events (<1 year) in women with a recent myocardial infarction (MI).
Observational studies have linked postmenopausal hormone use with a reduced risk of death from heart disease. However, a recent randomized trial of HRT found no long-term benefit, primarily due to an increase in cardiac events in the first year.
The Coumadin Aspirin Reinfarction Study (CARS) database contains information on HRT use and menopausal status for women with a recent MI. We classified the 1,857 postmenopausal women in CARS as prior/current HRT users if they took HRT before enrollment, new users if they began HRT during the study period or never users. We assessed the incidence of cardiac events (death, MI, unstable angina [UA]) during follow-up.
In our cohort, 28% (n = 524) used HRT at some point. Of these, 21% (n = 111) began HRT after their MI. New users had a higher incidence of death/MI/UA (41% vs. 28%, p = 0.001) during follow-up than never users, largely due to a higher incidence of UA (39% vs. 20%, p = 0.001). After adjustment, new users still had a significantly higher risk of death/MI/UA than never users during follow-up (relative risk [RR] = 1.44 [1.05-1.99]). Prior/current users had no excess risk of the composite end point after adjustment. Users of estrogen/progestin had a lower incidence of death/MI/UA during follow-up than users of estrogen only (RR = 0.56 [0.37-0.85]).
Postmenopausal women who initiated HRT after a recent MI had an increased risk of cardiac events largely due to excess UA during follow-up.
本研究探讨近期发生心肌梗死（MI）的女性开始激素替代疗法（HRT）与早期心脏事件（<1年）之间的关联。
观察性研究表明绝经后激素使用与心脏病死亡风险降低有关。然而，最近一项HRT随机试验未发现长期益处，主要是由于第一年心脏事件增加。
香豆素阿司匹林再梗死研究（CARS）数据库包含近期发生MI的女性的HRT使用和绝经状态信息。我们将CARS中1857名绝经后女性分类为：如果她们在入组前服用HRT，则为既往/当前HRT使用者；如果她们在研究期间开始HRT，则为新使用者；如果她们从未使用过HRT，则为从未使用者。我们评估了随访期间心脏事件（死亡、MI、不稳定型心绞痛[UA]）的发生率。
在我们的队列中，28%（n = 524）在某个时间点使用过HRT。其中，21%（n = 111）在MI后开始HRT。新使用者在随访期间死亡/MI/UA的发生率高于从未使用者（41%对28%，p = 0.001），主要是由于UA发生率较高（39%对20%，p = 0.001）。调整后，新使用者在随访期间死亡/MI/UA的风险仍显著高于从未使用者（相对风险[RR] = 1.44[1.05 - 1.99]）。调整后，既往/当前使用者的复合终点无额外风险。雌激素/孕激素使用者在随访期间死亡/MI/UA的发生率低于仅使用雌激素的使用者（RR = 0.56[0.37 - 0.85]）。
近期发生MI后开始HRT的绝经后女性心脏事件风险增加，主要是由于随访期间UA过多。
