Yuk Jin-Sung, Lee Jin San, Park Joong Hyun
Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Republic of Korea.
Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Front Aging Neurosci. 2023 Sep 7;15:1213481. doi: 10.3389/fnagi.2023.1213481. eCollection 2023.
Menopausal hormone therapy (MHT) is used to alleviate the symptoms associated with menopause, despite the lack of recommendations for MHT in preventing dementia. Recent nationwide studies have explored the association between MHT and dementia risk, but the findings remain limited. This study aims to investigate the association between MHT and the incidence of Alzheimer's disease (AD) and non-AD dementia using national population data from Korea.
We conducted a retrospective study using data from the National Health Insurance Service in Korea between January 1, 2002, and December 31, 2019. Women over 40 years were eligible for this study and classified into the MHT or non-MHT groups. The MHT group consisted of women who used Tibolone (TIB), combined estrogen plus progestin by the manufacturer (CEPM), estrogen, combined estrogen plus progestin by a physician (CEPP), and transdermal estrogen during menopause. We compared the risk of dementia between the MHT and non-MHT groups.
The study included 1,399,256 patients, of whom 387,477 were in the MHT group, and 1,011,779 were in the non-MHT group. The median duration of MHT was 23 months (range: 10-55 months). After adjusting for available confounders, we found that different types of MHT had varying effects on the occurrence of dementia. TIB (HR 1.041, 95% confidence interval (CI) 1.01-1.072) and oral estrogen alone (HR 1.081, 95% CI 1.03-1.134) were associated with a higher risk of AD dementia. In contrast, there was no difference in the risk of AD dementia by CEPM (HR 0.975, 95% CI 0.93-1.019), CEPP (HR 1.131, 95% CI 0.997-1.283), and transdermal estrogen (HR 0.989, 95% CI 0.757-1.292) use. The use of TIB, CEPM, and oral estrogen alone increased the risk of non-AD dementia (HR 1.335, 95% CI 1.303-1.368; HR 1.25, 95% CI 1.21-1.292; and HR 1.128, 95% CI 1.079-1.179; respectively), but there was no risk of non-AD dementia in the other MHT groups (CEPP and topical estrogen).
Our findings indicate that MHT has varying effects on the incidence of AD and non-AD dementia. Specifically, TIB, CEPM, and oral estrogen alone increase the risk of non-AD dementia, while transdermal estrogen is not associated with dementia risk. It is essential to consider the type of MHT used when assessing the risk of dementia in women.
尽管缺乏关于激素替代疗法（MHT）预防痴呆症的建议，但更年期激素疗法仍被用于缓解与更年期相关的症状。最近的全国性研究探讨了MHT与痴呆症风险之间的关联，但研究结果仍然有限。本研究旨在利用韩国的全国人口数据，调查MHT与阿尔茨海默病（AD）及非AD痴呆症发病率之间的关联。
我们使用了2002年1月1日至2019年12月31日期间韩国国民健康保险服务的数据进行了一项回顾性研究。40岁以上的女性符合本研究条件，并被分为MHT组或非MHT组。MHT组包括在更年期使用替勃龙（TIB）、制造商提供的雌激素加孕激素联合制剂（CEPM）、雌激素、医生开具的雌激素加孕激素联合制剂（CEPP）以及经皮雌激素的女性。我们比较了MHT组和非MHT组之间患痴呆症的风险。
该研究纳入了1399256名患者，其中MHT组有387477名，非MHT组有1011779名。MHT的中位持续时间为23个月（范围：10 - 55个月）。在对可用的混杂因素进行调整后，我们发现不同类型的MHT对痴呆症的发生有不同影响。TIB（风险比[HR] 1.041，95%置信区间[CI] 1.01 - 1.072）和单独使用口服雌激素（HR 1.081，95% CI 1.03 - 1.134）与AD痴呆症风险较高相关。相比之下，使用CEPM（HR 0.975，95% CI 0.93 - 1.019）、CEPP（HR 1.131，95% CI 0.997 - 1.283）和经皮雌激素（HR 0.989，95% CI 0.757 - 1.292）时，AD痴呆症风险没有差异。单独使用TIB、CEPM和口服雌激素会增加非AD痴呆症的风险（HR分别为1.335，95% CI 1.303 - 1.368；HR 1.25，95% CI 1.21 - 1.292；HR 1.128，95% CI 1.079 - 1.179），但其他MHT组（CEPP和外用雌激素）没有非AD痴呆症风险。
我们的研究结果表明，MHT对AD和非AD痴呆症的发病率有不同影响。具体而言，单独使用TIB、CEPM和口服雌激素会增加非AD痴呆症的风险，而经皮雌激素与痴呆症风险无关。在评估女性痴呆症风险时，必须考虑所使用的MHT类型。
