Division of Cardiology, Heart Institute and Department of Medicine, Cedars-Sinai Medical Center, 444 S. San Vicente Blvd., Los Angeles, CA 90048, USA.
Menopause. 2011 Sep;18(9):943-50. doi: 10.1097/gme.0b013e3182113672.
The aim of this study was to assess the relationship of the timing of hormone therapy (HT) use with angiographic coronary artery disease (CAD) and cardiovascular disease (CVD) events in women with natural versus surgical menopause.
We studied 654 postmenopausal women undergoing coronary angiography for the evaluation of suspected ischemia. Timing and type of menopause, HT use, and quantitative angiographic evaluations were obtained at baseline, and the women were followed for a median of 6 years for CVD events.
Ever users of HT had a significantly lower prevalence of obstructive CAD compared with never users (age-adjusted odds ratio, 0.41 [0.28-0.60]). Women with natural menopause initiating HT before age 55 years had lower CAD severity compared with never users (age-adjusted β [SE] = -6.23 [1.50], P < 0.0001), whereas those initiating HT at age 55 years or more did not differ statistically from never users (-3.34 [2.13], P = 0.12). HT use remained a significant predictor of obstructive CAD when adjusted for a "healthy user" model (odds ratio, 0.44 [0.30-0.73]; P = 0.002). An association between HT and fewer CVD events was observed only in the natural menopause group (hazard ratio [95% CI], 0.60 [0.41-0.88]; P = 0.009) but became nonsignificant when adjusted for the presence or severity of obstructive CAD.
Using the quantitative measurements of the timing and type of menopause and HT use, earlier initiation of HT was associated with less angiographic CAD in women with natural but not surgical menopause. Our data suggest that the effect of HT use on reduced cardiovascular event rates is mediated by the presence or absence of angiographic obstructive atherosclerosis.
本研究旨在评估激素治疗（HT）使用时机与自然绝经和手术绝经女性的血管造影冠状动脉疾病（CAD）和心血管疾病（CVD）事件之间的关系。
我们研究了 654 名因疑似缺血而行冠状动脉造影检查的绝经后妇女。在基线时获得了绝经的时间和类型、HT 使用情况以及定量血管造影评估，并对这些女性进行了中位 6 年的 CVD 事件随访。
曾使用 HT 的女性与从未使用过 HT 的女性相比，阻塞性 CAD 的患病率明显较低（年龄调整后的优势比，0.41 [0.28-0.60]）。自然绝经的女性在 55 岁之前开始使用 HT 的 CAD 严重程度低于从未使用者（年龄调整后的β[SE] = -6.23 [1.50]，P <0.0001），而 55 岁或以上开始使用 HT 的女性与从未使用者相比无统计学差异（-3.34 [2.13]，P = 0.12）。在调整“健康使用者”模型后，HT 使用仍然是阻塞性 CAD 的重要预测因素（优势比，0.44 [0.30-0.73]；P = 0.002）。仅在自然绝经组观察到 HT 与 CVD 事件减少之间存在关联（风险比[95%CI]，0.60 [0.41-0.88]；P = 0.009），但在调整了阻塞性 CAD 的存在或严重程度后，该关联不再具有统计学意义。
使用绝经的时间和类型以及 HT 使用的定量测量，自然绝经女性中 HT 的早期开始与血管造影 CAD 减少相关，但在手术绝经女性中则无相关性。我们的数据表明，HT 使用对降低心血管事件发生率的影响是由血管造影阻塞性动脉粥样硬化的存在或不存在介导的。
