Hlatky Mark A, Boothroyd Derek, Vittinghoff Eric, Sharp Penny, Whooley Mary A
Stanford University School of Medicine, HRP Redwood Bldg, Room 150, Stanford, CA 94305-5405, USA.
JAMA. 2002 Feb 6;287(5):591-7. doi: 10.1001/jama.287.5.591.
Postmenopausal hormone therapy is commonly used by women for disease prevention, but its effects on quality of life have not been well documented.
To determine the effect on quality of life of estrogen plus progestin therapy used as secondary prevention in women with coronary artery disease.
DESIGN, SETTING, AND PARTICIPANTS: A total of 2763 postmenopausal women with documented coronary artery disease (mean age, 67 years) in the Heart and Estrogen/Progestin Replacement Study, a randomized, placebo-controlled, double-blind trial conducted from January 1993 to July 1998 at outpatient and community settings at 20 US clinical centers.
Participants were randomly assigned to receive either 0.625 mg/d of conjugated equine estrogen plus 2.5 mg/d of medroxyprogesterone acetate (n = 1380) or placebo (n = 1383) for 36 months.
Physical activity, measured by the Duke Activity Status Index; energy/fatigue and mental health, measured by RAND scales; and depressive symptoms, measured on the Burnam screening scale, at 3 years of follow-up.
In all patients, scores declined significantly over 3 years for physical function (-3.8; P<.001), mental health (-0.6; P =.05), and energy/fatigue (-3.8; P<.001), but depressive symptoms were not significantly changed (P =.20). The effect of hormone therapy on these measures depended on the presence (n = 434) or absence (n = 2325) of flushing at study entry. Women with flushing who were assigned to hormone therapy had improved mental health (+2.6 vs - 0.5; P =.04) and fewer depressive symptoms (-0.5 vs + 0.007; P =.01) over follow-up compared with those assigned to placebo. Women without flushing who were assigned to hormone therapy had greater declines in physical function (-4.2 vs -3.3; P =.04) and energy/fatigue (-4.6 vs -3.1; P =.03) over follow-up. Quality-of-life scores were significantly lower among patients with older age, diabetes, hypertension, chest pain, or heart failure. These differences in quality of life among women classified by clinical characteristics were much greater than the effects of hormone therapy.
Hormone therapy has mixed effects on quality of life among older women. The effects of hormone therapy depend on the presence of menopausal symptoms; women without flushing had greater declines in physical measures, while women with flushing had improvements in emotional measures of quality of life.
绝经后激素治疗在女性中常用于疾病预防，但其对生活质量的影响尚无充分记录。
确定雌激素加孕激素治疗对冠心病女性二级预防中生活质量的影响。
设计、地点和参与者：心脏与雌激素/孕激素替代研究中共有2763名有冠心病记录的绝经后女性（平均年龄67岁），这是一项于1993年1月至1998年7月在美国20个临床中心的门诊和社区环境中进行的随机、安慰剂对照、双盲试验。
参与者被随机分配接受每日0.625毫克结合马雌激素加每日2.5毫克醋酸甲羟孕酮（n = 1380）或安慰剂（n = 1383），为期36个月。
随访3年时，通过杜克活动状态指数测量身体活动；通过兰德量表测量能量/疲劳和心理健康；通过伯纳姆筛查量表测量抑郁症状。
在所有患者中，3年期间身体功能（-3.8；P <.001）、心理健康（-0.6；P =.05）和能量/疲劳（-3.8；P <.001）得分显著下降，但抑郁症状无显著变化（P =.20）。激素治疗对这些指标的影响取决于研究开始时是否存在潮热（存在者n = 434，不存在者n = 2325）。与分配接受安慰剂治疗的女性相比，分配接受激素治疗且有潮热的女性在随访期间心理健康有所改善（+2.6对 -0.5；P =.04）且抑郁症状更少（-0.5对 +0.007；P =.01）。分配接受激素治疗且无潮热的女性在随访期间身体功能（-4.2对 -3.3；P =.04）和能量/疲劳（-4.6对 -3.1；P =.03）下降更大。年龄较大、患有糖尿病、高血压、胸痛或心力衰竭的患者生活质量得分显著更低。按临床特征分类的女性在生活质量方面存在的这些差异远大于激素治疗的影响。
激素治疗对老年女性生活质量的影响好坏参半。激素治疗的效果取决于是否存在绝经症状；无潮热的女性身体指标下降更大，而有潮热的女性生活质量的情感指标有所改善。
