Kalenga Cindy Z, Hay Jacqueline L, Boreskie Kevin F, Duhamel Todd A, MacRae Jennifer M, Metcalfe Amy, Nerenberg Kara A, Robert Magali, Ahmed Sofia B
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.
Front Cardiovasc Med. 2022 Jun 10;9:913609. doi: 10.3389/fcvm.2022.913609. eCollection 2022.
Postmenopausal hormone therapy (HT) is associated with increased cardiovascular risk. Although the route of estrogen administration may play a role in mediating risk, previous studies have not controlled for concomitant progestin use.
To investigate the association between the route of estrogen therapy (oral or non-oral) HT use, without concomitant progestin, and blood pressure and arterial stiffness in postmenopausal women.
Systolic blood pressure [SBP], diastolic blood pressure [DBP]), arterial stiffness (aortic pulse wave velocity [aPWV] and augmentation index at 75 beats per minute [AIx]) were measured using a validated automated brachial cuff-based oscillometric approach (Mobil-O-Graph) in a community-dwelling sample of 328 women.
Fifty-five participants (16.8%) were ever users (current and past use) of estrogen-only HT (oral [ = 16], transdermal [ = 20], vaginal [ = 19]), and 223 were never HT users (control). Ever use of oral estrogen was associated with increased SBP and DBP (Oral: SBP: 137 ± 4 mmHg, DBP: 79 ± 2 mmHg) compared to use of non-oral estrogen (transdermal: SBP: 118 ± 2 mmHg, DBP: 73 ± 1 mmHg; < 0.01 & = 0.012, respectively; vaginal: SBP: 123 ± 2 mmHg DBP: 73 ± 2 mmHg; = 0.02 & = 0.01, respectively.) and controls (SBP: 124 ± 1 mmHg, DBP: 74 ± 1 mmHg, = 0.03, = 0.02, respectively) after adjustment for covariates. aPWV was higher in oral estrogen ever users (9.9 ± 1 m/s) compared to non-oral estrogen (transdermal: 8.6 ± 0.3 m/s, < 0.01; vaginal: 8.8 ± 0.7 m/s, = 0.03) and controls (8.9 ± 0.5 m/s, = 0.03) but these associations were no longer significant after adjustment for covariates. AIx was higher in oral estrogen (29 ± 2 %) compared to non-oral estrogen (transdermal: 16 ± 2 %; vaginal: 22 ± 1.7 %) but this association was no longer significant after adjustment for covariates ( = 0.92 vs. non-oral; = 0.74 vs. control).
Ever use of oral estrogen was associated with increased SBP and DBP compared to non-oral estrogen use and no use. Given the cardiovascular risk associated with both menopause and increased blood pressure, further studies are required exploring the potential benefits of non-oral estrogen in postmenopausal women.
绝经后激素治疗（HT）与心血管风险增加相关。尽管雌激素给药途径可能在介导风险中起作用，但既往研究未对同时使用孕激素进行控制。
探讨未同时使用孕激素的雌激素治疗（口服或非口服）HT与绝经后女性血压和动脉僵硬度之间的关联。
采用经过验证的基于自动肱动脉袖带的示波法（Mobil-O-Graph），对328名社区居住女性样本测量收缩压[SBP]、舒张压[DBP]）、动脉僵硬度（主动脉脉搏波速度[aPWV]和每分钟75次心跳时的增强指数[AIx]）。
55名参与者（16.8%）曾使用过（目前和过去使用）仅含雌激素的HT（口服[ = 16]、经皮[ = 20]、阴道[ = 19]），223名从未使用过HT（对照）。与使用非口服雌激素（经皮：SBP：118±2 mmHg，DBP：73±1 mmHg；分别为<0.01和 = 0.012；阴道：SBP：123±2 mmHg，DBP：73±2 mmHg；分别为 = 0.02和 = 0.01）及对照组（SBP：124±1 mmHg，DBP：74±1 mmHg，分别为 = 0.03， = 0.02）相比，调整协变量后，曾使用口服雌激素与SBP和DBP升高相关。与非口服雌激素（经皮：8.6±0.3 m/s，<0.01；阴道：8.8±0.7 m/s， = 0.03）及对照组（8.9±0.5 m/s， = 0.03）相比，口服雌激素使用者的aPWV更高（9.9±1 m/s），但调整协变量后这些关联不再显著。与非口服雌激素（经皮：16±2%；阴道：22±1.7%）相比，口服雌激素的AIx更高（29±2%），但调整协变量后这种关联不再显著（与非口服相比 = 0.92；与对照相比 = 0.74）。
与使用非口服雌激素及未使用雌激素相比，曾使用口服雌激素与SBP和DBP升高相关。鉴于绝经和血压升高均与心血管风险相关，需要进一步研究探索非口服雌激素对绝经后女性的潜在益处。
