Venetkoski Minttu, Savolainen-Peltonen Hanna, Joensuu Johanna M, Gissler Mika, Ylikorkala Olavi, Mikkola Tomi S
University of Helsinki and Helsinki University Hospital, Department of Obstetrics and Gynecology, Haartmaninkatu 2, 00290 Helsinki, Finland.
Finnish Institute for Health and Welfare, Department of Knowledge Brokers, Mannerheimintie 166, 00300 Helsinki, Finland; Region Stockholm, Academic Primary Health Care Centre, Solnavägen 1 E, 113 65 Stockholm, Sweden; Karolinska Institutet, Department of Molecular Medicine and Surgery, 171 77 Stockholm, Sweden.
Maturitas. 2024 Nov;189:108112. doi: 10.1016/j.maturitas.2024.108112. Epub 2024 Sep 4.
Women with prior pre-eclampsia are at increased risk of cardiovascular disease (CVD). Menopausal hormone therapy (MHT) may affect this risk. We evaluated the impact of MHT use on cardiovascular risk between women with and without prior pre-eclampsia.
We assessed the occurrence of any CVD, myocardial infarction (MI) and stroke in MHT users (n = 9700) and non-users (n = 19,914) with prior pre-eclampsia, and likewise in MHT users (n = 27,764) and non-users (n = 58,248) without prior pre-eclampsia over the period 1994-2019. Follow-up started at MHT initiation (mean age 50.4 in pre-eclamptic women and 50.3 in non-pre-eclamptic women) and lasted for a mean of 13.3 years.
The use of MHT in prior pre-eclamptic women was associated with significant risk reductions for any CVD (HR 0.85, 95 % CI 0.78-0.91), MI (HR 0.66, 95 % CI 0.55-0.78) and stroke events (HR 0.71, 95 % CI 0.63-0.81) in comparison with non-users with prior pre-eclampsia. The risk reductions for cardiovascular deaths were even more pronounced (HR 0.43, 95 % CI 0.31-0.59 for any CVD death; HR 0.49, 95 % CI 0.30-0.80 for MI death; HR 0.25, 95 % CI 0.10-0.64 for stroke death). However, none of these risk reductions differed from those seen in MHT users without prior pre-eclampsia. The risk of any CVD decreased already within five years of MHT use in women with prior pre-eclampsia but not in those without prior pre-eclampsia.
The use of MHT is associated with reduced CVD risk in women with prior pre-eclampsia. This is important to clinicians considering the initiation of MHT for recently menopausal women with prior pre-eclampsia.
既往有子痫前期病史的女性患心血管疾病（CVD）的风险增加。绝经激素治疗（MHT）可能会影响这一风险。我们评估了MHT的使用对有和没有子痫前期病史的女性心血管风险的影响。
我们评估了1994年至2019年期间有子痫前期病史的MHT使用者（n = 9700）和非使用者（n = 19914）以及无子痫前期病史的MHT使用者（n = 27764）和非使用者（n = 58248）中任何CVD、心肌梗死（MI）和中风的发生情况。随访从开始使用MHT时开始（子痫前期女性的平均年龄为50.4岁，非子痫前期女性为50.3岁），平均持续13.3年。
与有子痫前期病史的非使用者相比，有子痫前期病史的女性使用MHT可显著降低任何CVD（风险比[HR] 0.85，95%置信区间[CI] 0.78 - 0.91）、MI（HR 0.66，95% CI 0.55 - 0.78）和中风事件（HR 0.71，95% CI 0.63 - 0.81）的风险。心血管死亡风险的降低更为显著（任何CVD死亡的HR 0.43，95% CI 0.31 - 0.59；MI死亡的HR 0.49，95% CI 0.30 - 0.80；中风死亡的HR 0.25，95% CI 0.10 - 0.64）。然而，这些风险降低与无子痫前期病史的MHT使用者中观察到的风险降低没有差异。有子痫前期病史的女性在使用MHT五年内任何CVD的风险就已经降低，但无子痫前期病史的女性则没有。
使用MHT与有子痫前期病史的女性CVD风险降低有关。这对于考虑为近期绝经且有子痫前期病史的女性开始使用MHT的临床医生来说很重要。
