Windler Eberhard, Zyriax Birgit-Christiane, Eidenmüller Britta, Boeing Heiner
Center of Internal Medicine, University Hospital Hamburg-Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
Maturitas. 2007 Jul 20;57(3):239-46. doi: 10.1016/j.maturitas.2007.01.004. Epub 2007 Feb 9.
Hormone replacement therapy (HRT) has been suggested to prevent cardiovascular disease, while some intervention studies have shed doubt on this concept. Thus, uncertainty remains whether current HRT use is beneficial as to cardiovascular disease or may even be harmful.
This research investigates the association of hormone replacement therapy, risk factors and lifestyle characteristics with the manifestation of coronary heart disease in current HRT users versus never users.
The coronary risk factors for atherosclerosis in women study (CORA-study) provide clinical and biochemical parameters and data on lifestyle in 200 consecutive pre- and postmenopausal women with incident coronary heart disease compared to 255 age-matched population-based controls, of which 87.9% were postmenopausal.
Significantly more controls than cases used currently HRT for a median of 9.5 years (32.9% versus 20.2%), while 50.0% of cases and 42.5% of controls had never used HRT (p<0.02). Compared to women who never used HRT, current users ate less meat and sausage, had a significantly lower BMI and waist-to-hip ratio and a lower prevalence of hypertension, insulin resistance and diabetes. However, current users among cases were often smokers and smoked significantly more cigarettes than never users. In a multivariate analysis the risk of current HRT users for coronary artery disease was 57% lower than the risk of never users (odds ratio 0.428, CI 0.206-0.860, p<0.02). Adjustment for conventional and dietary risk factors revealed neither current HRT use, nor HRT use combined with smoking as independent risk factors.
These data from the CORA-study are not compatible with an adverse impact of hormone replacement therapy on cardiovascular disease, rather support the notion of beneficial effects of HRT on weight, central adiposity, insulin sensitivity and blood pressure. Yet, the data do not support the presumption of a general healthy user effect in women on HRT either. Rather, in some women adverse lifestyle habits, especially intense smoking, appear to counteract possible beneficial effects of HRT.
激素替代疗法（HRT）曾被认为可预防心血管疾病，但一些干预研究对此观点提出了质疑。因此，目前使用HRT对心血管疾病是有益还是甚至可能有害，仍存在不确定性。
本研究调查激素替代疗法、危险因素和生活方式特征与当前使用HRT者和从未使用者冠心病表现之间的关联。
女性动脉粥样硬化冠心病危险因素研究（CORA研究）提供了200例连续的绝经前后患冠心病女性与255例年龄匹配的基于人群的对照者的临床和生化参数以及生活方式数据，其中87.9%为绝经后女性。
目前使用HRT的对照者显著多于病例组，中位使用时间为9.5年（32.9%对20.2%），而50.0%的病例组和42.5%的对照者从未使用过HRT（p<0.02）。与从未使用HRT的女性相比，当前使用者摄入的肉类和香肠较少，BMI和腰臀比显著更低，高血压、胰岛素抵抗和糖尿病的患病率也更低。然而，病例组中的当前使用者经常吸烟，且吸烟量显著多于从未使用者。在多变量分析中，当前使用HRT者患冠心病的风险比从未使用者低57%（优势比0.428，可信区间0.206 - 0.860，p<0.02）。对传统和饮食危险因素进行调整后发现，当前使用HRT以及HRT与吸烟联合使用均不是独立的危险因素。
CORA研究的这些数据与激素替代疗法对心血管疾病有不良影响不相符，反而支持了HRT对体重、中心性肥胖、胰岛素敏感性和血压有有益作用的观点。然而，这些数据也不支持女性使用HRT存在普遍健康使用者效应的假设。相反，在一些女性中，不良的生活习惯，尤其是大量吸烟，似乎抵消了HRT可能的有益作用。
