Hsia Judith, Criqui Michael H, Rodabough Rebecca J, Langer Robert D, Resnick Helaine E, Phillips Lawrence S, Allison Matthew, Bonds Denise E, Masaki Kamal, Caralis Panagiota, Kotchen Jane M
Department of Medicine, George Washington University, Washington, DC, USA.
Circulation. 2004 Feb 10;109(5):620-6. doi: 10.1161/01.CIR.0000115309.63979.92.
Observational studies have reported less frequent carotid atherosclerosis in healthy women taking postmenopausal hormone therapy. Estrogen with progestin did not reduce peripheral arterial events among women with preexisting coronary heart disease. This analysis evaluates clinical peripheral arterial disease among generally healthy women in the Women's Health Initiative randomized trial of estrogen plus progestin.
The Estrogen Plus Progestin trial assigned 16 608 postmenopausal women, mean age 63.3+/-7.1 years, to daily conjugated estrogens (0.625 mg) with medroxyprogesterone acetate (2.5 mg) or placebo and documented health outcomes over an average of 5.6 years of follow-up. Hospitalization for peripheral arterial disease was infrequent, with annualized rates of 0.08%, 0.06%, and 0.02% for carotid disease, lower extremity arterial disease, and abdominal aortic aneurysm, respectively. The incidence of peripheral arterial events did not differ between treatment groups (hazard ratio [HR] 0.89, 95% confidence interval 0.63, 1.25). The risk was slightly greater among women assigned to active estrogen with progestin in years 1 (HR 1.33) and 2 (HR 1.27), and was slightly lower in later years (HR 0.85 and 0.87 in years 5 and > or =6). Among adherent participants, the hazard ratio for peripheral arterial events was 1.23 (95% confidence interval 0.79, 1.91) over the 5.6 years of follow up. Subgroup analysis identified no significant interactions between estrogen with progestin and baseline characteristics with regard to peripheral arterial disease risk.
Among generally healthy postmenopausal women, conjugated estrogens with progestin did not confer protection against peripheral arterial disease.
观察性研究报告称，服用绝经后激素疗法的健康女性颈动脉粥样硬化的发生率较低。雌激素加孕激素并不能降低已有冠心病女性的外周动脉事件发生率。本分析评估了妇女健康倡议雌激素加孕激素随机试验中一般健康女性的临床外周动脉疾病情况。
雌激素加孕激素试验将16608名平均年龄为63.3±7.1岁的绝经后女性随机分为两组，一组每日服用结合雌激素（0.625毫克）加醋酸甲羟孕酮（2.5毫克），另一组服用安慰剂，并记录了平均5.6年随访期内的健康结局。外周动脉疾病住院情况不常见，颈动脉疾病、下肢动脉疾病和腹主动脉瘤的年化发生率分别为0.08%、0.06%和0.02%。治疗组之间外周动脉事件的发生率没有差异（风险比[HR]为0.89，95%置信区间为0.63，1.25）。在第1年（HR为1.33）和第2年（HR为1.27），分配到活性雌激素加孕激素组的女性风险略高，而在随后几年风险略低（第5年和≥6年的HR分别为0.85和0.87）。在坚持服药的参与者中，5.6年随访期内外周动脉事件的风险比为1.23（95%置信区间为0.79，1.91）。亚组分析未发现雌激素加孕激素与外周动脉疾病风险的基线特征之间存在显著相互作用。
在一般健康的绝经后女性中，结合雌激素加孕激素并不能预防外周动脉疾病。
