绝经后状态和早发绝经作为心血管疾病的独立危险因素：一项荟萃分析。

Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis.

作者信息

Atsma Femke, Bartelink Marie-Louise E L, Grobbee Diederick E, van der Schouw Yvonne T

机构信息

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.

出版信息

Menopause. 2006 Mar-Apr;13(2):265-79. doi: 10.1097/01.gme.0000218683.97338.ea.

DOI:10.1097/01.gme.0000218683.97338.ea

PMID:16645540

Abstract

OBJECTIVE

Loss of ovarian function and subsequent deficiency of endogenous estrogens is suggested to enhance cardiovascular disease risk and related death after menopause. The aim was to obtain valid estimates of the cardiovascular disease risk associated with postmenopausal status and early menopause.

DESIGN

A literature search of observational studies was performed using PubMed and EMBASE (1966 to May 1, 2004). Eighteen studies on postmenopausal status and age at menopause in relation to cardiovascular disease were selected. Six studies investigated menopausal status, nine studies investigated menopausal age, and three studied both. General variance-based methods were used to pool relative risk estimates and corresponding 95% confidence intervals. Stratification was performed for study design, type of menopause, outcome, and adjustment for age and smoking.

RESULTS

The pooled relative risk estimate for postmenopausal versus premenopausal status and cardiovascular disease was 1.36 (95% CI, 1.15-1.60). In the stratified analysis, the pooled effect was 0.96 (95% CI, 0.77-1.21) after controlling for age and smoking. The pooled effect of bilateral oophorectomy on cardiovascular disease was 2.62 (95% CI, 2.05-3.35). For early menopause and cardiovascular disease, with the menopausal age category containing 50 years as a reference, the pooled relative risk estimate was 1.25 (95% CI, 1.15-1.35). In the stratified analysis, the pooled effect was 1.38 (95% CI, 1.21-1.58) after controlling for age and smoking. The pooled effect of bilateral oophorectomy on cardiovascular disease was 4.55 (95% CI, 2.56-8.01).

CONCLUSIONS

Overall, there was no convincing relationship between postmenopausal status and cardiovascular disease. However, there was a modest effect of early menopause on cardiovascular disease. The effect was more pronounced for women with an artificial menopause than for women with a natural menopause.

摘要

目的

卵巢功能丧失及内源性雌激素随后缺乏被认为会增加绝经后心血管疾病风险及相关死亡风险。目的是获得与绝经后状态和早绝经相关的心血管疾病风险的有效估计值。

设计

使用PubMed和EMBASE（1966年至2004年5月1日）对观察性研究进行文献检索。选择了18项关于绝经后状态和绝经年龄与心血管疾病关系的研究。6项研究调查了绝经状态，9项研究调查了绝经年龄，3项研究两者都进行了调查。使用基于一般方差的方法汇总相对风险估计值和相应的95%置信区间。对研究设计、绝经类型、结局以及年龄和吸烟调整进行了分层分析。

结果

绝经后与绝经前状态及心血管疾病的汇总相对风险估计值为1.36（95%置信区间，1.15 - 1.60）。在分层分析中，控制年龄和吸烟后汇总效应为0.96（95%置信区间，0.77 - 1.21）。双侧卵巢切除术对心血管疾病的汇总效应为2.62（95%置信区间，2.05 - 3.35）。对于早绝经和心血管疾病，以绝经年龄类别包含50岁作为参照，汇总相对风险估计值为1.25（95%置信区间，1.15 - 1.35）。在分层分析中，控制年龄和吸烟后汇总效应为1.38（95%置信区间，1.21 - 1.58）。双侧卵巢切除术对心血管疾病的汇总效应为4.55（95%置信区间，2.56 - 8.01）。