Departments of Medicine.
Obstetrics, Gynecology, and Reproductive Sciences.
Menopause. 2018 Nov;25(11):1286-1290. doi: 10.1097/GME.0000000000001230.
The aim of this study was to examine interactions between hot flushes, estrogen plus progestogen therapy (EPT), and coronary heart disease (CHD) events in postmenopausal women with CHD.
We analyzed data from the Heart and Estrogen/Progestin Replacement Study, a randomized, placebo-controlled trial of 0.625 mg conjugated equine estrogens plus 2.5 mg medroxyprogesterone acetate in 2,763 postmenopausal women with CHD. Hot flushes were assessed at baseline using self-administered questionnaires; women reporting bothersome hot flushes "some" to "all" of the time were considered to have clinically significant flushing. Cox regression models were used to examine the effect of EPT on risk of CHD events among women with and without significant flushing at baseline.
The mean age of participants was 66.7 ± 6.8 years, and 89% (n = 2,448) were white. Sixteen percent (n = 434) of participants reported clinically significant hot flushes at baseline. Among women with baseline flushing, EPT increased risk of CHD events nine-fold in the first year compared with placebo (hazard ratio = 9.01; 95% CI, 1.15-70.35); among women without baseline flushing, treatment did not significantly affect CHD event risk in the first year (hazard ratio = 1.32; 95% CI, 0.86-2.03; P = 0.07 for interaction of hot flushes with treatment). The trend toward differential effects of EPT on risk for CHD among women with and without baseline flushing did not persist after the first year of treatment.
Among older postmenopausal women with CHD, EPT may increase risk of CHD events substantially in the first year of treatment among women with clinically significant hot flushes but not among those without hot flushes.
本研究旨在探讨绝经后冠心病（CHD）女性中热潮、雌孕激素联合治疗（EPT）与冠心病事件之间的相互作用。
我们分析了心脏与雌激素/孕激素替代研究（Heart and Estrogen/Progestin Replacement Study）的数据，该研究是一项随机、安慰剂对照试验，纳入了 2763 例有 CHD 的绝经后妇女，给予 0.625mg 结合型马雌激素加 2.5mg 甲羟孕酮醋酸酯治疗。使用自我报告问卷在基线时评估热潮，报告“有时”到“一直”有烦扰性热潮的女性被认为有明显的热潮。采用 Cox 回归模型来研究 EPT 对有和无基线时明显热潮的女性发生 CHD 事件风险的影响。
参与者的平均年龄为 66.7±6.8 岁，89%（n=2448）为白人。16%（n=434）的参与者在基线时报告有明显的热潮。在基线时有热潮的女性中，EPT 在第一年增加了 9 倍的 CHD 事件风险，与安慰剂相比（危险比=9.01；95%置信区间，1.15-70.35）；在基线时无热潮的女性中，治疗第一年 CHD 事件风险无显著变化（危险比=1.32；95%置信区间，0.86-2.03；EPT 与治疗之间的交互作用 P=0.07）。EPT 对基线时有和无热潮的女性发生 CHD 的风险的影响存在差异的趋势在治疗的第一年之后并未持续。
在有 CHD 的老年绝经后女性中，EPT 可能会在第一年显著增加有明显热潮的女性发生 CHD 事件的风险，但对无热潮的女性没有影响。
