妇女健康倡议前后的冠心病死亡率和激素治疗。

Coronary heart disease mortality and hormone therapy before and after the Women's Health Initiative.

机构信息

Department of Obstetrics and Gynecology, Helsinki University Central Hospital, the National Institute for Health and Welfare, and the Folkhälsan Research Center, Helsinki, and the EPID Research Oy, Espoo, Finland; and the Nordic School of Public Health, Gothenburg, Sweden.

出版信息

Obstet Gynecol. 2014 Nov;124(5):947-953. doi: 10.1097/AOG.0000000000000461.

DOI:10.1097/AOG.0000000000000461

PMID:25437723

Abstract

OBJECTIVE

To assess whether coronary heart disease mortality in Finnish hormone therapy (HT) users differed before and after 2002 when the Women's Health Initiative study was published.

METHODS

The risks of coronary heart disease death in HT users in relation to the age-matched background population were compared between the pre- (1995-2001) and post- (2002-2009) Women's Health Initiative eras. We used a nationwide register on HT (ie, estradiol with or without progestin) reimbursement and linked them to causes of death in 290,272 women aged 40 years or older.

RESULTS

Exposure to HT for 1 year or less was accompanied by a 29% reduction (0.71; 0.63-0.80; three per 10,000 fewer deaths) and an exposure of 1-8 years with a 43% reduction (0.57; 0.48-0.66; three per 10,000 fewer deaths) in the risk of coronary heart disease death in the pre-Women's Health Initiative era. In the post-Women's Health Initiative era, HT use of 1 year or less was associated with an 18% reduction (0.82; 0.76-1.00; one per 10,000 fewer deaths) and an exposure of 1-8 years with a 54% reduction (0.46; 0.32-0.64; two per 10,000 fewer deaths) in coronary heart disease mortality. Discontinuation of HT was associated with an increased risk of cardiac death of 42% (1.42; 1.17-1.71; seven per 10,000 extra deaths) in the pre-Women's Health Initiative era and 31% (1.31; 0.92-1.82; two per 10,000 extra deaths) in the post-Women's Health Initiative era during the first posttreatment year. This risk increase vanished in further follow-up during both eras.

CONCLUSION

Changes in HT use after the Women's Health Initiative failed to affect coronary heart disease mortality of HT users in this nationwide study.

摘要

目的

评估在 2002 年《妇女健康倡议研究》公布后，芬兰激素治疗（HT）使用者的冠心病死亡率是否发生了变化。

方法

在《妇女健康倡议》前后两个时期（1995-2001 年和 2002-2009 年），比较 HT 使用者与年龄匹配的背景人群的冠心病死亡风险。我们使用全国性的 HT（即雌二醇加或不加孕激素）报销登记系统，并将其与 290272 名年龄在 40 岁及以上的女性的死因相关联。

结果

在《妇女健康倡议》之前的时期，HT 暴露 1 年或更短时间与冠心病死亡风险降低 29%（0.71；0.63-0.80；每 10000 人死亡人数减少 3 人），暴露 1-8 年与冠心病死亡风险降低 43%（0.57；0.48-0.66；每 10000 人死亡人数减少 3 人）相关。在《妇女健康倡议》之后的时期，HT 暴露 1 年或更短时间与冠心病死亡风险降低 18%（0.82；0.76-1.00；每 10000 人死亡人数减少 1 人）相关，暴露 1-8 年与冠心病死亡风险降低 54%（0.46；0.32-0.64；每 10000 人死亡人数减少 2 人）相关。HT 停药与停药后第一年的心脏死亡风险增加 42%（1.42；1.17-1.71；每 10000 人死亡人数增加 7 人）相关，与《妇女健康倡议》之后的时期相比，停药后第一年的心脏死亡风险增加 31%（1.31；0.92-1.82；每 10000 人死亡人数增加 2 人）相关。在两个时期的进一步随访中，这种风险增加都消失了。