Crandall Carolyn J, Hovey Kathleen M, Andrews Christopher, Cauley Jane A, Stefanick Marcia, Shufelt Chrisandra, Prentice Ross L, Kaunitz Andrew M, Eaton Charles, Wactawski-Wende Jean, Manson JoAnn E
1Department of Medicine, University of California, Los Angeles, Los Angeles, CA 2Dept of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo, NY 3Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI 4Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 5Department of Medicine, Stanford University School of Medicine, Stanford, CA 6Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 7Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 8Department of Obstetrics and Gynecology, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 9Department of Family Medicine and Epidemiology, Brown University Warren Alpert Medical School and School of Public Health, Pawtucket, RI 10Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY 11Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Menopause. 2017 Oct;24(10):1145-1153. doi: 10.1097/GME.0000000000000899.
To examine associations of estrogen preparations with an index of health risks versus benefits.
Using data from 45,112 participants of the Women's Health Initiative Observational Study (average follow-up 5.5 years), we examined associations of estrogen type and oral conjugated equine estrogen (CEE) dose with time to first global index event (GIE), defined as coronary heart disease, breast cancer, stroke, pulmonary embolism, hip fracture, colorectal cancer, endometrial cancer, or death.
Oral CEE less than 0.625 mg/d + progestogen (P) users had a lower risk of a GIE (adjusted hazard ratio 0.74, 95% confidence interval 0.56-0.97) than oral CEE 0.625 mg/d + P users. GIE risk in oral CEE 0.625 mg/d + P users was greater with at least 5-year use (adjusted hazard ratio 1.22, 95% confidence interval 1.06-1.41) than with less than 5-year use. In women with prior hysterectomy, compared with women taking oral CEE 0.625 mg/d for less than 5 years, GIE risk was similar with oral CEE below 0.625 mg/d, oral estradiol (E2), and transdermal E2, whether used for less than 5 years or for at least 5 years. There was no difference in GIE risk between users of the following: oral CEE + P versus oral E2 + P; oral CEE + P versus transdermal E2 + P; oral E2 + P versus transdermal E2 + P. Findings were similar among women with hysterectomy taking estrogen alone.
The summary index of risks versus benefits was similar for oral CEE versus oral or transdermal E2-containing regimens. CEE + P containing less than 0.625 mg/d of CEE (vs 0.625 mg/d) for less than 5 years appeared safer.
研究雌激素制剂与健康风险效益指数之间的关联。
利用女性健康倡议观察性研究中45112名参与者的数据（平均随访5.5年），我们研究了雌激素类型和口服共轭马雌激素（CEE）剂量与首次发生综合指数事件（GIE）的时间之间的关联，GIE定义为冠心病、乳腺癌、中风、肺栓塞、髋部骨折、结直肠癌、子宫内膜癌或死亡。
口服CEE剂量低于0.625mg/d并加用孕激素（P）的使用者发生GIE的风险（校正风险比0.74，95%置信区间0.56 - 0.97）低于口服CEE 0.625mg/d并加用P的使用者。口服CEE 0.625mg/d并加用P的使用者中，使用至少5年的GIE风险（校正风险比1.22，95%置信区间1.06 - 1.41）高于使用不足5年的情况。在既往接受子宫切除术的女性中，与口服CEE 0.625mg/d不足5年的女性相比，口服CEE低于0.625mg/d、口服雌二醇（E2）和经皮E2的GIE风险相似，无论使用不足5年还是至少5年。以下使用者之间的GIE风险无差异：口服CEE + P与口服E2 + P；口服CEE + P与经皮E2 + P；口服E2 + P与经皮E2 + P。在单独服用雌激素的子宫切除术后女性中，研究结果相似。
口服CEE与含口服或经皮E2的方案的风险效益综合指数相似。含CEE低于0.625mg/d（对比0.625mg/d）且使用不足5年的CEE + P似乎更安全。
