Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Office of Research and Development, Seattle, WA.
Menopause. 2021 Jul 26;28(10):1125-1129. doi: 10.1097/GME.0000000000001823.
Hormone therapy (HT) is used by menopausal women to treat vasomotor symptoms. Venous thromboembolism (VTE) is an important risk of HT use, and more knowledge on the comparative safety of different estrogenic compounds is useful for women who use HT for these symptoms. The objective was to compare the risk of VTE among users of oral conjugated equine estrogen (CEE), oral estradiol (E2), and transdermal E2, in a cohort of women veterans.
This retrospective cohort study included all women veterans aged 40 to 89 years, using CEE or E2, without prior VTE, between 2003 and 2011. All incident VTE events were adjudicated. Time-to-event analyses using a time-varying HT exposure evaluated the relative VTE risk between estrogen subtypes, with adjustment for age, race, and body mass index, with stratification for prevalent versus incident use of HT.
Among 51,571 users of HT (74.5% CEE, 12.6% oral, and 12.9% transdermal E2 at cohort entry), with a mean age of 54.0 years, the incidence of VTE was 1.9/1,000 person-years. Compared with CEE use, in the multivariable regression model, there was no difference in the risk of incident VTE associated with oral E2 use (hazard ratio 0.96, 95% CI 0.64-1.46) or with transdermal E2 use (hazard ratio 0.95, 95% CI 0.60-1.49). Results were unchanged when restricting to incident users of HT.
Among women veterans, the risk of VTE was similar in users of oral CEE, oral E2, and transdermal E2. These findings do not confirm the previously observed greater safety of transdermal and oral E2 over CEE.
激素疗法（HT）被绝经后女性用于治疗血管舒缩症状。静脉血栓栓塞（VTE）是 HT 使用的一个重要风险，更多关于不同雌激素化合物相对安全性的知识，对于因这些症状而使用 HT 的女性是有用的。本研究的目的是比较口服结合雌激素（CEE）、口服雌二醇（E2）和经皮 E2 使用者发生 VTE 的风险，研究对象为一群女性退伍军人。
这是一项回顾性队列研究，纳入了 2003 年至 2011 年间年龄在 40 至 89 岁之间、无 VTE 既往史、使用 CEE 或 E2 的所有女性退伍军人。所有新发 VTE 事件均经裁决。采用时变 HT 暴露的时间-事件分析，评估了雌激素亚型之间相对 VTE 风险，调整了年龄、种族和体重指数，并分层分析了 HT 预先使用和新发使用。
在 51571 名使用 HT 的患者（74.5%为 CEE、12.6%为口服 E2、12.9%为经皮 E2）中，平均年龄为 54.0 岁，VTE 的发生率为 1.9/1000 人年。与 CEE 相比，在多变量回归模型中，口服 E2 （危险比 0.96，95%置信区间 0.64-1.46）或经皮 E2 （危险比 0.95，95%置信区间 0.60-1.49）使用与新发 VTE 风险无关。当限制为 HT 的新发使用者时，结果不变。
在女性退伍军人中，口服 CEE、口服 E2 和经皮 E2 使用者的 VTE 风险相似。这些发现不能证实先前观察到的经皮和口服 E2 比 CEE 更安全。
