Prentice Ross L, Manson Joann E, Langer Robert D, Anderson Garnet L, Pettinger Mary, Jackson Rebecca D, Johnson Karen C, Kuller Lewis H, Lane Dorothy S, Wactawski-Wende Jean, Brzyski Robert, Allison Matthew, Ockene Judith, Sarto Gloria, Rossouw Jacques E
Fred Hutchinson Cancer Research Center, Seattle,Washington 98109-1024, USA.
Am J Epidemiol. 2009 Jul 1;170(1):12-23. doi: 10.1093/aje/kwp115. Epub 2009 May 25.
The authors further analyzed results from the Women's Health Initiative randomized trials (1993-2004) of conjugated equine estrogens, with or without medroxyprogesterone acetate, focusing on health benefits versus risks among women who initiated hormone therapy soon after menopause. Data from the Women's Health Initiative observational study (1993-2004) were included in some analyses for additional precision. Results are presented here for incident coronary heart disease, stroke, venous thromboembolism, breast cancer, colorectal cancer, endometrial cancer, or hip fracture; death from other causes; a summary global index; total cancer; and total mortality. Hazard ratios for breast cancer and total cancer were comparatively higher (P < 0.05) among women who initiated hormone therapy soon after menopause, for both regimens. Among these women, use of conjugated equine estrogens appeared to produce elevations in venous thromboembolism and stroke and a reduction in hip fracture. Estrogen plus progestin results among women who initiated use soon after menopause were similar for venous thromboembolism, stroke, and hip fracture but also included evidence of longer-term elevations in breast cancer, total cancer, and the global index. These analyses provide little support for the hypothesis of favorable effects among women who initiate postmenopausal estrogen use soon after menopause, either for coronary heart disease or for health benefits versus risk indices considered.
作者进一步分析了妇女健康倡议（1993 - 2004年）中关于结合马雌激素（无论是否添加醋酸甲羟孕酮）的随机试验结果，重点关注绝经后不久开始激素治疗的女性的健康益处与风险。妇女健康倡议观察性研究（1993 - 2004年）的数据被纳入一些分析以提高精确度。这里展示了关于冠心病、中风、静脉血栓栓塞、乳腺癌、结直肠癌、子宫内膜癌或髋部骨折的发病情况；其他原因导致的死亡；一个综合总体指标；总癌症；以及总死亡率的结果。对于两种治疗方案，绝经后不久开始激素治疗的女性中，乳腺癌和总癌症的风险比相对较高（P < 0.05）。在这些女性中，使用结合马雌激素似乎会导致静脉血栓栓塞和中风发生率升高，以及髋部骨折发生率降低。绝经后不久开始使用雌激素加孕激素的女性，在静脉血栓栓塞、中风和髋部骨折方面的结果相似，但也有证据表明乳腺癌、总癌症和总体指标在长期内会升高。这些分析几乎没有支持这样的假设，即绝经后不久开始使用绝经后雌激素的女性会有有益影响，无论是对于冠心病还是对于所考虑的健康益处与风险指标。
