Alexandersen P, Tankó L B, Bagger Y Z, Qin G, Christiansen C
Center for Clinical and Basic Research, Ballerup, Denmark.
Climacteric. 2006 Apr;9(2):108-18. doi: 10.1080/13697130600647743.
The effect of hormone replacement therapy (HRT) on cardiovascular risk is intensely debated. The aim of this study was to investigate the long-term effects of HRT given for a few years on all-cause and cardiovascular mortality and the severity of atherosclerosis.
This analysis was based on a cohort of 1,458 postmenopausal women (55.8 +/- 6.1 years old) who previously participated in a number of randomized, placebo-controlled, clinical trials assessing the efficacy of 2-3 years of therapy with various estrogen plus progestin combinations for preventing bone loss. Women were followed on average for 9.8 years and came for a follow-up visit. Outcome variables were all-cause and cardiovascular mortality and the severity of atherosclerosis, as estimated by semi-quantitative scoring of vascular calcification in the lumbar aorta on lateral radiographs.
A total of 174 women died during the observation period. All-cause mortality was decreased by 30% in the HRT+ group compared with the HRT- group (hazard ratio (HR) 0.70; 95% confidence interval (CI) 0.50-0.97) after adjusting for age, body mass index and smoking. Under the same conditions, similar results characterized mortality from cardiovascular disease (n = 61 deaths; 35.1% of all deaths) and coronary heart disease (n = 39 deaths; 22.4% of all deaths), which were decreased by 46% (HR 0.54, 95% CI 0.29-0.98, p = 0.045) and 53% (HR 0.47, 95% CI 0.21-1.03, p = 0.062), respectively. Furthermore, the mean severity score of aortic calcification at follow-up was significantly lower in hormone-treated compared to non-treated women (p < 0.0001).
Women who receive 2-3 years of HRT after menopause do not have increased all-cause mortality, and results of the present study suggest relative cardiovascular benefits compared to those who had not used hormones.
激素替代疗法（HRT）对心血管风险的影响存在激烈争论。本研究的目的是调查数年HRT对全因死亡率、心血管死亡率以及动脉粥样硬化严重程度的长期影响。
该分析基于一组1458名绝经后女性（55.8±6.1岁），她们此前参与了多项随机、安慰剂对照临床试验，评估2 - 3年各种雌激素加孕激素组合疗法预防骨质流失的疗效。女性平均随访9.8年并前来进行随访。结局变量为全因死亡率、心血管死亡率以及动脉粥样硬化严重程度，通过腰椎侧位X线片上主动脉钙化的半定量评分来估计。
观察期内共有174名女性死亡。在调整年龄、体重指数和吸烟因素后，HRT +组的全因死亡率较HRT -组降低了30%（风险比（HR）0.70；95%置信区间（CI）0.50 - 0.97）。在相同条件下，心血管疾病（n = 61例死亡；占所有死亡的35.1%）和冠心病（n = 39例死亡；占所有死亡的22.4%）的死亡率也有类似结果，分别降低了46%（HR 0.54，95% CI 0.29 - 0.98，p = 0.045）和53%（HR = 0.47，95% CI 0.21 - 1.03，p = 0.062）。此外，随访时激素治疗组的主动脉钙化平均严重程度评分显著低于未治疗组女性（p < 0.0001）。
绝经后接受2 - 3年HRT的女性全因死亡率并未增加，本研究结果表明与未使用激素的女性相比，HRT有相对的心血管益处。
