Miller Virginia M, Harman S Mitchell
Departments of Surgery and Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota; and
Kronos Longevity Research Institute and the Phoenix Veterans Administration Health Care System, Phoenix, Arizona.
Am J Physiol Heart Circ Physiol. 2017 Nov 1;313(5):H1013-H1021. doi: 10.1152/ajpheart.00383.2017. Epub 2017 Aug 11.
The worlds of observational, clinical, and basic science collided in 2002 with the publication of results of the Women's Health Initiative (WHI), a large-scale, prospective, blinded, randomized-controlled trial designed to provide evidence regarding use of hormone treatment to prevent cardiovascular disease in menopausal women. The results of the WHI dramatically changed clinical practice, negatively impacted funding for hormone research, and left scientists to unravel the "why" of the results. Now over a decade and a half since the initial publication of the WHI results, basic and clinical scientists often do not interpret the results of the WHI with the precision needed to move the science forward. This review will ) describe the historical background leading up to the WHI, ) list the outcomes from the WHI, and put them in perspective with results of subsequent analysis of the WHI data and results from other prospective menopausal hormone treatment trials addressing cardiovascular effects of menopausal hormone use, and ) articulate how the collective results are influencing current clinical care with the intent to provide guidance for designing and evaluating relevant new hormonal studies.
2002年，观察性科学、临床科学和基础科学领域因妇女健康倡议（WHI）研究结果的发表而产生了碰撞。妇女健康倡议是一项大规模、前瞻性、盲法、随机对照试验，旨在为使用激素治疗预防绝经后妇女心血管疾病提供证据。妇女健康倡议的结果极大地改变了临床实践，对激素研究的资金投入产生了负面影响，并让科学家们去探究这些结果背后的“原因”。自妇女健康倡议结果首次发表至今已过去十五年多，基础科学家和临床科学家常常未能以推动科学进步所需的精准度来解读妇女健康倡议的结果。本综述将：（1）描述妇女健康倡议之前的历史背景；（2）列出妇女健康倡议的结果，并结合对妇女健康倡议数据的后续分析结果以及其他针对绝经激素使用对心血管影响的前瞻性绝经激素治疗试验结果，对这些结果进行审视；（3）阐明这些综合结果如何影响当前的临床护理，旨在为设计和评估相关新激素研究提供指导。
