From the 1Hormones and Cardiovascular Disease, Center for Research in Epidemiology and Population Health, Villejuif, France; 2Université Paris Sud, UMRS 1018, Villejuif, France; 3Paris Descartes University and Cochin-Port Royal Hospital, Paris, France; 4Department of Obstetrics and Gynecology, Miller School of Medicine, University of Miami, Miami, FL; 5Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA; 6University of Washington School of Nursing, Seattle, WA; and 7Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Menopause. 2014 Mar;21(3):214-20. doi: 10.1097/GME.0b013e31829752e0.
This study aims to investigate venous thromboembolism (VTE) risk in relation to age at menopause, age at menarche, parity, bilateral oophorectomy, and time since menopause, as well as any interaction with randomized hormone therapy (HT) assignment, among postmenopausal women.
Using pooled data from the Women's Health Initiative HT clinical trials including 27,035 postmenopausal women aged 50 to 79 years who had no history of VTE, we assessed the risk of VTE in relation to age at menopause, age at menarche, parity, bilateral oophorectomy, and time since menopause by Cox proportional hazards models. Linear trends, quadratic relationships, and interactions of reproductive life characteristics with HT on VTE risk were systematically tested.
During follow-up, 426 women reported a first VTE, including 294 non-procedure-related events. No apparent interaction of reproductive life characteristics with HT assignment on VTE risk was detected, and there was not a significant association between VTE and age at menarche, age at menopause, parity, oophorectomy, or time since menopause. However, analyses restricted to non-procedure-related VTE showed a U-shaped relationship between age at menopause and thrombotic risk that persisted after multivariable analysis (P < 0.01). Compared with women aged 40 to 49 years at menopause, those who had early menopause (age <40 y) or late menopause (age >55 y) had a significantly increased VTE risk (hazard ratio [95% CI]: 1.8 [1.2-2.7] and 1.5 [1.0-2.4], respectively).
Reproductive life characteristics have little association with VTE and do not seem to influence the effect of HT on thrombotic risk among postmenopausal women. Nevertheless, early and late onset of menopause might be newly identified risk factors for non-procedure-related VTE.
本研究旨在探讨与绝经年龄、初潮年龄、产次、双侧卵巢切除术以及绝经后时间相关的静脉血栓栓塞症（VTE）风险，以及这些因素与随机激素治疗（HT）分配之间的相互作用，以评估其在绝经后妇女中的作用。
利用来自妇女健康倡议 HT 临床试验的汇总数据，纳入了 27035 名年龄在 50 至 79 岁之间、无 VTE 病史的绝经后妇女，我们通过 Cox 比例风险模型评估了与绝经年龄、初潮年龄、产次、双侧卵巢切除术以及绝经后时间相关的 VTE 风险。系统地测试了生殖生命特征与 HT 对 VTE 风险的线性趋势、二次关系和相互作用。
在随访期间，426 名女性报告了首次 VTE，其中 294 例为非手术相关事件。未发现生殖生命特征与 HT 分配对 VTE 风险的明显交互作用，且 VTE 与初潮年龄、绝经年龄、产次、卵巢切除术或绝经后时间之间没有显著关联。然而，对非手术相关 VTE 的分析显示，绝经年龄与血栓形成风险之间呈 U 形关系，且在多变量分析后仍然存在（P < 0.01）。与绝经年龄在 40 至 49 岁的女性相比，早绝经（<40 岁）或晚绝经（>55 岁）的女性 VTE 风险显著增加（危险比[95%CI]：1.8[1.2-2.7]和 1.5[1.0-2.4]）。
生殖生命特征与 VTE 的相关性较小，且似乎不会影响 HT 对绝经后妇女血栓形成风险的影响。然而，早绝经和晚绝经可能是新发现的非手术相关 VTE 的危险因素。
