Barsky Lili, Shufelt Chrisandra, Lauzon Marie, Johnson B Delia, Berga Sarah L, Braunstein Glenn, Bittner Vera, Shaw Leslee, Reis Steven, Handberg Eileen, Pepine Carl J, Bairey Merz C Noel
Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
J Womens Health (Larchmt). 2021 Mar;30(3):377-384. doi: 10.1089/jwh.2020.8743. Epub 2021 Jan 21.
Previous Women's Ischemia Syndrome Evaluation (WISE) work demonstrated prior oral contraceptive (OC) use was associated with lower coronary artery disease (CAD) in women with suspected ischemia. The association of prior OC use with longer term all-cause and cardiovascular disease (CVD) mortality is unclear. WISE women undergoing coronary angiography for suspected ischemia (enrolled 1996-2001) with prior OC use history and 10-year follow-up data were analyzed. A blinded core laboratory assessed atherosclerotic CAD severity. Kaplan-Meier analyses evaluated prior OC use relative to all-cause and CVD mortality. Cox regression analyses adjusted for baseline differences. Mediation, interaction, and multicollinearity were analyzed. Our 686 women had a mean age 62.5 ± 9.6 years, multiple cardiac risk factors, and 39% previously used OC. Prior OC users were younger, with less lipid-lowering medication use and lower atherosclerotic CAD severity scores (all < 0.05). Prior OC use was associated with lower 10-year all-cause ( = 0.007) and CVD mortality ( = 0.019). After adjustment, this was no longer significant ( = 0.77 and = 0.90, respectively). Atherosclerotic CAD severity score mediated one-third of the observed association. Prior OC use was associated with increased CVD mortality among women with very elevated menopausal systolic blood pressure (SBP). Unadjusted prior OC use was associated with lower longer-term all-cause and CVD mortality. One-third of this observed effect appears mediated by the atherosclerotic CAD severity score. Prior OC was adversely associated with CVD mortality in women with very elevated menopausal SBP. Additional investigation is needed to understand the potential benefits and harms of prior OC use. Clinical Trial Number: NCT00000554, or https://www.clinicaltrials.gov/ct2/show/NCT00000554.
既往女性缺血综合征评估（WISE）研究表明，在疑似缺血的女性中，既往口服避孕药（OC）的使用与较低的冠状动脉疾病（CAD）相关。既往OC使用与长期全因死亡率和心血管疾病（CVD）死亡率之间的关联尚不清楚。对1996年至2001年期间因疑似缺血接受冠状动脉造影且有既往OC使用史的WISE女性以及10年随访数据进行了分析。一个盲法核心实验室评估动脉粥样硬化性CAD的严重程度。Kaplan-Meier分析评估了既往OC使用与全因死亡率和CVD死亡率的关系。Cox回归分析对基线差异进行了调整。分析了中介作用、相互作用和多重共线性。我们的686名女性平均年龄为62.5±9.6岁，有多种心脏危险因素，39%的女性既往使用过OC。既往OC使用者更年轻，使用降脂药物较少，动脉粥样硬化性CAD严重程度评分较低（均P<0.05）。既往OC使用与较低的10年全因死亡率（P=0.007）和CVD死亡率（P=0.019）相关。调整后，这不再具有统计学意义（分别为P=0.77和P=0.90）。动脉粥样硬化性CAD严重程度评分介导了观察到的关联的三分之一。在绝经后收缩压（SBP）非常高的女性中，既往OC使用与CVD死亡率增加相关。未调整的既往OC使用与较低的长期全因死亡率和CVD死亡率相关。观察到的这种效应的三分之一似乎由动脉粥样硬化性CAD严重程度评分介导。在绝经后SBP非常高的女性中，既往OC与CVD死亡率呈负相关。需要进一步研究以了解既往OC使用的潜在益处和危害。临床试验编号：NCT00000554，或https://www.clinicaltrials.gov/ct2/show/NCT00000554 。
