Department of Obstetrics and Gynaecology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea.
BJOG. 2024 Aug;131(9):1306-1317. doi: 10.1111/1471-0528.17803. Epub 2024 Mar 11.
To evaluate the association between menopausal hormonal therapy (MHT) and the risk of cardiovascular disease (CVD), according to various regimens, dosages, routes of administration and starting ages of MHT.
A population-based cohort study using the Korean National Health Insurance Services database.
Nationwide health insurance database.
Women who reported entering menopause at an age of ≥40 years with no history of CVD in the national health examination.
The study population comprised 1 120 705 subjects enrolled between 2002 and 2019, categorised according to MHT status (MHT group, n = 319 007; non-MHT group, n = 801 698).
Incidence of CVD (a composite of myocardial infarction and stroke).
The incidence of CVD was 59 266 (7.4%) in the non-MHT group and 17 674 (5.5%) in the MHT group. After adjusting for confounding factors, an increased risk of CVD was observed with the administration of tibolone (hazard ratio, HR 1.143, 95% CI 1.117-1.170), oral estrogen (HR 1.246, 95% CI 1.198-1.295) or transdermal estrogen (HR 1.289, 95% CI 1.066-1.558), compared with the non-MHT group; the risk was based on an increased risk of stroke. The risk trends were consistent regardless of the age of starting MHT or the physicians' specialty. Among tibolone users, a longer period from entering menopause to taking tibolone and the use of any dosage (1.25 or 2.5 mg) were linked with a higher risk of CVD, compared with non-MHT users.
This nationwide cohort study demonstrated an increased risk of CVD, driven mainly by an increased risk of stroke, among tibolone and oral or transdermal estrogen users, compared with that of non-MHT users.
根据不同的方案、剂量、给药途径和 MHT 起始年龄，评估绝经激素治疗（MHT）与心血管疾病（CVD）风险之间的关系。
利用韩国国家健康保险服务数据库进行的基于人群的队列研究。
全国性健康保险数据库。
在全国健康检查中报告年龄≥40 岁进入绝经期且无 CVD 病史的女性。
研究人群包括 2002 年至 2019 年间纳入的 1120705 名受试者，根据 MHT 状况进行分类（MHT 组，n=319007；非 MHT 组，n=801698）。
CVD 发生率（心肌梗死和中风的复合事件）。
非 MHT 组的 CVD 发生率为 59266（7.4%），MHT 组为 17674（5.5%）。调整混杂因素后，与非 MHT 组相比，替勃龙（风险比，HR 1.143，95%置信区间 1.117-1.170）、口服雌激素（HR 1.246，95%置信区间 1.198-1.295）或经皮雌激素（HR 1.289，95%置信区间 1.066-1.558）治疗与 CVD 风险增加相关；这种风险增加主要归因于中风风险的增加。无论 MHT 起始年龄或医生专业如何，风险趋势均一致。在替勃龙使用者中，与非 MHT 使用者相比，从绝经到开始使用替勃龙的时间较长（1.25 或 2.5mg）与 CVD 风险升高相关。
这项全国性队列研究表明，与非 MHT 使用者相比，替勃龙和口服或经皮雌激素使用者 CVD 风险增加，主要归因于中风风险增加。
