From the 1Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA; 2Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA; 3National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; 4MedStar Health Research Institute, Hyattsville, MD; 5University of Florida College of Medicine-Jacksonville, Jacksonville, FL; 6Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; 7George Washington University School of Medicine and Health Sciences, Washington, DC; 8Atlanta VA Medical Center, Decatur, GA; 9Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, GA; and 10Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Menopause. 2014 Mar;21(3):260-6. doi: 10.1097/GME.0b013e31829a64f9.
Research comparing hormone therapy (HT) doses, regimens, and routes of delivery in relation to cardiovascular disease (CVD) outcomes has been limited. This study directly compared different estrogen doses, routes of delivery, and HT formulations in postmenopausal women in relation to the risk of coronary heart disease (CHD), stroke, CVD mortality, total CVD, and all-cause mortality.
The Women's Health Initiative Observational Study is a multicenter prospective cohort study that was conducted at 40 US sites. Analyses included 93,676 postmenopausal women aged 50 to 79 years at study entry who were recruited from September 1994 to December 1998, with annual follow-up through August 14, 2009.
The mean follow-up was 10.4 years. In direct comparisons, oral estradiol was associated with lower hazard ratios (HRs) for stroke than oral conjugated equine estrogens (CEE; HR, 0.64; 95% CI, 0.40-1.02), but statistical power was limited. Similarly, transdermal estradiol was associated with a moderate but nonsignificantly lower risk of CHD compared with oral CEE (HR, 0.63; 95% CI, 0.37-1.06). For other outcomes, comparisons revealed no appreciable differences by estrogen doses, formulations, or routes of delivery. Absolute risks of CVD events and all-cause mortality were markedly lower in younger women compared with older women.
In direct comparisons, various HT doses and regimens are associated with similar rates of cardiovascular events and all-cause mortality. However, oral estradiol may be associated with a lower risk of stroke, and transdermal estradiol may be associated with a lower risk of CHD, compared with conventional-dose oral CEE. Additional research is needed to confirm these hypotheses.
有关激素治疗（HT）剂量、方案和给药途径与心血管疾病（CVD）结局关系的研究一直较为有限。本研究直接比较了不同剂量的雌激素、给药途径和 HT 制剂在绝经后妇女中的应用，以评估其与冠心病（CHD）、中风、CVD 死亡率、总 CVD 和全因死亡率的相关性。
妇女健康倡议观察性研究是一项多中心前瞻性队列研究，在美国 40 个地点进行。分析纳入了 93676 名年龄在 50 至 79 岁之间、于研究开始时绝经的女性，这些女性于 1994 年 9 月至 1998 年 12 月期间被招募入组，随访至 2009 年 8 月 14 日。
平均随访时间为 10.4 年。在直接比较中，与口服结合雌激素（CEE）相比，口服雌二醇与较低的中风风险比（HR）相关（HR，0.64；95%置信区间，0.40-1.02），但统计效能有限。同样，与口服 CEE 相比，经皮雌二醇与 CHD 风险降低相关，但差异无统计学意义（HR，0.63；95%置信区间，0.37-1.06）。对于其他结局，比较结果显示，雌激素剂量、制剂或给药途径之间无明显差异。与老年女性相比，年轻女性的 CVD 事件和全因死亡率的绝对风险明显较低。
在直接比较中，各种 HT 剂量和方案与心血管事件和全因死亡率的发生率相似。然而，与常规剂量的口服 CEE 相比，口服雌二醇可能与较低的中风风险相关，而经皮雌二醇可能与较低的 CHD 风险相关。需要进一步的研究来证实这些假设。
