Stampfer M J, Colditz G A, Willett W C, Manson J E, Rosner B, Speizer F E, Hennekens C H
Channing Laboratory, Boston, MA 02115.
N Engl J Med. 1991 Sep 12;325(11):756-62. doi: 10.1056/NEJM199109123251102.
The effect of postmenopausal estrogen therapy on the risk of cardiovascular disease remains controversial. Our 1985 report in the Journal, based on four years of follow-up, suggested that estrogen therapy reduced the risk of coronary heart disease, but a report published simultaneously from the Framingham Study suggested that the risk was increased. In addition, studies of the effect of estrogens on stroke have yielded conflicting results.
We followed 48,470 postmenopausal women, 30 to 63 years old, who were participants in the Nurses' Health Study, and who did not have a history of cancer or cardiovascular disease at base line. During up to 10 years of follow-up (337,854 person-years), we documented 224 strokes, 405 cases of major coronary disease (nonfatal myocardial infarctions or deaths from coronary causes), and 1263 deaths from all causes.
After adjustment for age and other risk factors, the overall relative risk of major coronary disease in women currently taking estrogen was 0.56 (95 percent confidence interval, 0.40 to 0.80); the risk was significantly reduced among women with either natural or surgical menopause. We observed no effect of the duration of estrogen use independent of age. The findings were similar in analyses limited to women who had recently visited their physicians (relative risk, 0.45; 95 percent confidence interval, 0.31 to 0.66) and in a low-risk group that excluded women reporting current cigarette smoking, diabetes, hypertension, hypercholesterolemia, or a Quetelet index above the 90th percentile (relative risk, 0.53; 95 percent confidence interval, 0.31 to 0.91). The relative risk for current and former users of estrogen as compared with those who had never used it was 0.89 (95 percent confidence interval, 0.78 to 1.00) for total mortality and 0.72 (95 percent confidence interval, 0.55 to 0.95) for mortality from cardiovascular disease. The relative risk of stroke when current users were compared with those who had never used estrogen was 0.97 (95 percent confidence interval, 0.65 to 1.45), with no marked differences according to type of stroke.
Current estrogen use is associated with a reduction in the incidence of coronary heart disease as well as in mortality from cardiovascular disease, but it is not associated with any change in the risk of stroke.
绝经后雌激素治疗对心血管疾病风险的影响仍存在争议。我们1985年发表在《杂志》上的报告基于四年的随访，表明雌激素治疗可降低冠心病风险，但同时发表的弗雷明汉姆研究报告则表明风险会增加。此外，关于雌激素对中风影响的研究结果也相互矛盾。
我们对48470名年龄在30至63岁之间、参加护士健康研究且基线时无癌症或心血管疾病史的绝经后女性进行了随访。在长达10年的随访期（337854人年）内，我们记录了224例中风、405例主要冠心病（非致命性心肌梗死或冠心病死亡）以及1263例各种原因导致的死亡。
在对年龄和其他风险因素进行调整后，目前正在服用雌激素的女性患主要冠心病的总体相对风险为0.56（95%置信区间为0.40至0.80）；在自然绝经或手术绝经的女性中，风险显著降低。我们未观察到独立于年龄的雌激素使用持续时间的影响。在仅限于近期看过医生的女性的分析中（相对风险为0.45；95%置信区间为0.31至0.66）以及在排除报告当前吸烟、糖尿病、高血压、高胆固醇血症或体重指数高于第90百分位数的女性的低风险组中（相对风险为0.53；95%置信区间为0.31至0.91），研究结果相似。与从未使用过雌激素的女性相比，当前和既往使用雌激素的女性的总死亡率相对风险为0.89（95%置信区间为0.78至1.00），心血管疾病死亡率相对风险为0.72（95%置信区间为0.55至0.95）。与从未使用过雌激素的女性相比时，当前使用者中风的相对风险为0.97（95%置信区间为0.65至1.45），不同类型中风之间无明显差异。
当前使用雌激素与冠心病发病率以及心血管疾病死亡率的降低相关，但与中风风险的任何变化无关。
