Hernandez Avila M, Walker A M, Jick H
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115.
Epidemiology. 1990 Mar;1(2):128-33. doi: 10.1097/00001648-199003000-00008.
We evaluated the relation between postmenopausal estrogen use and the risk of first-time myocardial infarction using both cohort and nested case-control analyses for data derived from a large health maintenance organization. The study population comprised all women aged 50 to 64 years who were members of the Group Health Cooperative of Puget Sound during the years 1978-1984. In the cohort analysis of 120 cases of first-time myocardial infarction that occurred during 17,513 woman-years at risk among current users and 110,971 woman-years at risk among nonusers of replacement estrogens, the relative incidence of myocardial infarction among current users compared with nonusers, adjusted for age and calendar year, was 0.7 (95% confidence interval 0.4-1.3). This small inverse relation between myocardial infarction and current use of replacement estrogens remained unchanged after adjustment in the case-control study for previous prescription of diuretics and antiarhythmic, antihypertensive, and antidiabetic drugs. These data are consistent with previous observations that estrogen replacement therapy causes a small reduction in the risk of hospitalization for myocardial infarction, and incompatible with any large increase in the risk of myocardial infarction in users of replacement estrogen.
我们使用队列分析和巢式病例对照分析，对来自一个大型健康维护组织的数据进行评估，以研究绝经后雌激素使用与首次心肌梗死风险之间的关系。研究人群包括1978年至1984年期间普吉特海湾集团健康合作社的所有50至64岁女性。在队列分析中，当前使用者中有120例首次心肌梗死发生在17,513人年的风险期内，非替代雌激素使用者中有110,971人年的风险期。经年龄和日历年调整后，当前使用者与非使用者相比，心肌梗死的相对发病率为0.7（95%置信区间0.4 - 1.3）。在病例对照研究中，对利尿剂、抗心律失常药、抗高血压药和抗糖尿病药的既往处方进行调整后，心肌梗死与当前使用替代雌激素之间的这种小的反向关系保持不变。这些数据与先前的观察结果一致，即雌激素替代疗法会使心肌梗死住院风险略有降低，与替代雌激素使用者中任何大幅增加的心肌梗死风险不相符。
