Lemaitre Rozenn N, Weiss Noel S, Smith Nicholas L, Psaty Bruce M, Lumley Thomas, Larson Eric B, Heckbert Susan R
Cardiovascular Health Research Unit, Department of Medicine, University of Washington, and Center for Health Studies, Group Health Cooperative, Seattle 98101-1448, USA.
Arch Intern Med. 2006 Feb 27;166(4):399-404. doi: 10.1001/archinte.166.4.399.
Clinical trials of conjugated equine estrogen (CEE) or estradiol vs placebo in postmenopausal women have found no effect or an elevated risk of myocardial infarction (MI) and stroke. The association of these end points with the use of esterified estrogen (EE) is unknown.
We examined the risk of MI and stroke associated with current use of CEE, use of EE, or nonuse of hormones in a population-based case-control study in a health maintenance organization. Cases were all postmenopausal women with an incident MI (n = 1644) or stroke (n = 1080). Controls (n = 4205) consisted of a random sample of postmenopausal women without MI or stroke. Current use of postmenopausal hormones was assessed using a computerized pharmacy database.
There was no difference in risk of MI or stroke associated with current use of CEE or EE compared with nonuse or for current use of CEE compared with EE. In analyses restricted to hormone users, there was a suggestion of higher ischemic stroke risk associated with CEE alone (without progestin) compared with EE alone (odds ratio, 1.57; 95% confidence interval, 0.98-2.53). There was also a suggestion that when initiated in the previous 6 months, CEE was associated with a higher risk of MI than EE (odds ratio, 2.33; 95% confidence interval, 0.93-5.82).
Further study may be warranted of the effects of EE on the risk of cardiovascular end points.
在绝经后女性中，结合马雌激素（CEE）或雌二醇与安慰剂的临床试验发现，心肌梗死（MI）和中风的发生率无影响或有所升高。这些终点与使用酯化雌激素（EE）之间的关联尚不清楚。
在一个健康维护组织中进行的基于人群的病例对照研究中，我们研究了当前使用CEE、使用EE或不使用激素与MI和中风风险之间的关系。病例为所有发生MI（n = 1644）或中风（n = 1080）的绝经后女性。对照（n = 4205）由无MI或中风的绝经后女性随机样本组成。使用计算机化药房数据库评估绝经后激素的当前使用情况。
与不使用相比，当前使用CEE或EE与MI或中风风险之间无差异，与使用EE相比，当前使用CEE也无差异。在仅限于激素使用者的分析中，与单独使用EE相比，单独使用CEE（无孕激素）有更高的缺血性中风风险（优势比，1.57；95%置信区间，0.98 - 2.53）。还有迹象表明，在前6个月开始使用时，CEE与MI风险高于EE相关（优势比，2.33；95%置信区间，0.93 - 5.82）。
可能有必要进一步研究EE对心血管终点风险的影响。
