Rockman Caron B, Maldonado Thomas S, Jacobowitz Glenn R, Adelman Mark A, Riles Thomas S
Division of Vascular Surgery, New York University Medical Center, New York, NY 10016, USA.
Ann Vasc Surg. 2012 Apr;26(3):411-8. doi: 10.1016/j.avsg.2011.10.012. Epub 2012 Jan 30.
The effect of hormone replacement therapy (HRT) in postmenopausal women on the development of peripheral atherosclerosis remains in question. The goal of this study was to analyze the use of HRT in a large population of postmenopausal women and to determine its association with the prevalence of peripheral arterial disease (PAD).
A prospective database of patients who underwent voluntary vascular screening was used. Identification of patients as postmenopausal, and their use of HRT, was based on patient questionnaires. PAD was defined to be present if either lower extremity ankle-brachial index was ≤0.9.
Analysis was performed on data from 847,982 postmenopausal women; 433,178 (51.1%) reported having used HRT. HRT subjects were slightly older than patients who had not used HRT (64.5 years vs. 63.6 years). Caucasian women were significantly more likely to have used HRT than non-Caucasian women (52.4% vs. 47.6%). HRT subjects were significantly more likely to have smoked cigarettes (42.8% vs. 40.6%), to have hypertension (47.9% vs. 45.1%), and to have hypercholesterolemia (55% vs. 51.5%) than women who had not used HRT (all P < 0.001). However, HRT subjects were significantly less likely to have diabetes mellitus (8.6% vs. 10.2%, P < 0.001). Despite the increased prevalence of several atherosclerotic risk factors among women who used HRT, they were significantly less likely to have PAD (3.3% vs. 4.1%, P < 0.001). Multivariate analysis adjusting for age, race, and medical comorbidities that predispose toward the development of atherosclerosis confirmed that HRT was independently associated with a decreased risk of PAD (odds ratio: 0.8, 95% confidence interval: 0.78-0.82). In subsets of postmenopausal women with known atherosclerotic risk factors, the significant effect of HRT on the prevalence of PAD was maintained; in women with either a smoking history, hypertension, hypercholesterolemia, diabetes, or age of ≥70 years, the odds ratio of HRT use with regard to PAD remained approximately 0.8.
The use of HRT in postmenopausal women appears to be associated with a significant reduction in the prevalence of PAD in this population-based study. This association appeared to be significant even in postmenopausal women with known atherosclerotic risk factors. These observational data may suggest a relationship between HRT and the prevalence of PAD that has not been the specific subject of previous randomized prospective studies.
绝经后女性激素替代疗法（HRT）对周围动脉粥样硬化发展的影响仍存在疑问。本研究的目的是分析大量绝经后女性中HRT的使用情况，并确定其与周围动脉疾病（PAD）患病率的关联。
使用一个接受自愿血管筛查患者的前瞻性数据库。根据患者问卷确定患者是否为绝经后女性及其HRT的使用情况。如果下肢踝臂指数≤0.9，则定义为存在PAD。
对847,982名绝经后女性的数据进行了分析；433,178名（51.1%）报告使用过HRT。使用HRT的受试者比未使用HRT的患者稍年长（64.5岁对63.6岁）。白人女性使用HRT的可能性显著高于非白人女性（52.4%对47.6%）。与未使用HRT的女性相比，使用HRT的受试者吸烟（42.8%对40.6%）、患高血压（47.9%对45.1%）和高胆固醇血症（55%对51.5%）的可能性显著更高（所有P<0.001）。然而，使用HRT的受试者患糖尿病的可能性显著更低（8.6%对10.2%，P<0.001）。尽管使用HRT的女性中几种动脉粥样硬化危险因素的患病率有所增加，但她们患PAD的可能性显著更低（3.3%对4.1%，P<0.001）。对年龄、种族和易患动脉粥样硬化的合并症进行校正的多变量分析证实，HRT与PAD风险降低独立相关（优势比：0.8，95%置信区间：0.78 - 0.82）。在已知有动脉粥样硬化危险因素的绝经后女性亚组中，HRT对PAD患病率的显著影响得以维持；在有吸烟史、高血压、高胆固醇血症、糖尿病或年龄≥70岁的女性中，使用HRT与PAD相关的优势比仍约为0.8。
在这项基于人群的研究中，绝经后女性使用HRT似乎与该人群中PAD患病率的显著降低相关。即使在已知有动脉粥样硬化危险因素的绝经后女性中，这种关联似乎也很显著。这些观察数据可能提示HRT与PAD患病率之间存在一种此前随机前瞻性研究未专门涉及的关系。
