Mikkola Tomi S, Tuomikoski Pauliina, Lyytinen Heli, Korhonen Pasi, Hoti Fabian, Vattulainen Pia, Gissler Mika, Ylikorkala Olavi
Department of Obstetrics and Gynecology (T.S.M., P.T., O.Y.), Helsinki University Hospital, 00029 Helsinki, Finland; Folkhälsan Research Center (T.S.M.), 00250 Helsinki, Finland; EPID Research Oy (H.L., P.K., F.H., P.V.), 02130 Espoo, Finland; National Institute for Health and Welfare (M.G.), 00271 Helsinki, Finland; and Nordic School of Public Health (M.G.), 40242 Gothenburg, Sweden.
J Clin Endocrinol Metab. 2015 Dec;100(12):4588-94. doi: 10.1210/jc.2015-1864. Epub 2015 Sep 28.
Current guidelines recommend annual discontinuation of postmenopausal hormone therapy (HT) to evaluate whether a woman could manage without the treatment. The impact of HT on cardiovascular health has been widely studied, but it is not known how the withdrawal of HT affects cardiovascular risk.
We evaluated the risk of cardiac or stroke death after the discontinuation of HT. Design, Patients, Interventions, and Main Outcome Measures: Altogether 332 202 Finnish women discontinuing HT between 1994 and 2009 (data from National Reimbursement register) were followed up from the discontinuation date to death due to cardiac cause (n = 3177) or stroke (n = 1952), or to the end of 2009. The deaths, retrieved from the national Cause of Death Register, were compared with the expected number of deaths in the age-standardized background population. In a subanalysis we also compared HT stoppers with HT users.
Within the first posttreatment year, the risk of cardiac death was significantly elevated (standardized mortality ratio; 95% confidence interval 1.26; 1.16-1.37), whereas follow-up for longer than 1 year was accompanied with a reduction (0.75; 0.72-0.78). The risk of stroke death in the first posttreatment year was increased (1.63; 1.47-1.79), but follow-up for longer than 1 year was accompanied with a reduced risk (0.89; 0.85-0.94). The cardiac (2.30; 2.12-2.50) and stroke (2.52; 2.28-2.77) death risk elevations were even higher when compared with HT users. In women who discontinued HT at age younger than 60 years, but not in women aged 60 years or older, the cardiac mortality risk was elevated (1.94; 1.51-2.48).
Increased cardiovascular death risks question the safety of annual HT discontinuation practice to evaluate whether a woman could manage without HT.
当前指南建议每年停用绝经后激素治疗（HT），以评估女性在无该治疗的情况下是否能够维持。HT对心血管健康的影响已得到广泛研究，但尚不清楚停用HT如何影响心血管风险。
我们评估了停用HT后心脏或中风死亡的风险。设计、患者、干预措施及主要结局指标：总共332202名在1994年至2009年间停用HT的芬兰女性（数据来自国家报销登记处），从停药日期开始随访至因心脏原因死亡（n = 3177）或中风死亡（n = 1952），或至2009年底。从国家死亡原因登记处获取的死亡数据与年龄标准化背景人群中的预期死亡人数进行比较。在一项亚分析中，我们还比较了停用HT者与使用HT者。
在治疗后的第一年内，心脏死亡风险显著升高（标准化死亡率；95%置信区间1.26；1.16 - 1.37），而随访超过1年则风险降低（0.75；0.72 - 0.78）。治疗后第一年内中风死亡风险增加（1.63；1.47 - 1.79），但随访超过1年风险降低（0.89；0.85 - 0.94）。与使用HT者相比，心脏（2.30；2.12 - 2.50）和中风（2.52；2.28 - 2.77）死亡风险升高更为明显。在60岁以下停用HT的女性中，心脏死亡风险升高（1.94；1.51 - 2.48），而60岁及以上女性则未出现这种情况。
心血管死亡风险增加对每年停用HT以评估女性在无HT情况下能否维持的安全性提出了质疑。
