Yuk Jin-Sung, Kim Gwang Sil, Kim Dong-Gil, Byun Young Sup, Kim Myoung-Hwan, Yoon Sang-Hee, Han Gwan Hee, Kim Byung Gyu
Department of Obstetrics and Gynecology, Sanggye Paik Hospital, School of Medicine, Inje University, 1342 Dongil-ro, Nowon-Gu, Seoul 01757, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-Gu, Seoul 01757, Republic of Korea.
Eur J Endocrinol. 2025 Feb 1;192(2):73-80. doi: 10.1093/ejendo/lvae161.
To evaluate the association between various regimens and combinations of menopausal hormone therapy (MHT) and the risk of cardiovascular disease (CVD) in clinical practice.
This was a population-based cohort study.
This population-based cohort study used data from the Health Insurance Review and Assessment Service. The data of women who reported entering menopause at ≥40 years of age with no history of CVD in the national health examination between 2011 and 2014 were extracted. A total of 134 298 pairs were included in the MHT and non-MHT groups after 1:1 propensity score matching. The participants were followed until December, 31, 2020.
During a median follow-up of 7.9 (IQR 6.9-8.9) years, the incidences of CVD were 146 per 100 000 person/year and 179 per 100 000 person/year for the non-MHT and MHT groups, respectively. After adjusting for covariates, MHT use was associated with an increased CVD risk (hazard ratio [HR], 1.22 [1.14-1.31]) compared with the non-MHT group; the risk was based on an increased risk of stroke and coronary artery revascularization. Tibolone (HR, 1.38, [1.27-1.50]) was associated with increased CVD, but estrogen alone or combined estrogen/progestogen was not. There was no difference in CVD risk, regardless of the type of estrogen agent used. For combined estrogen/progestogen therapy, dydrogesterone was associated with reduced CVD risk.
There was an increased risk of CVD in MHT users. By regimen, tibolone use was associated with increased risk of CVD, whereas estrogen either alone or in combination with progestogen was not. There was no difference according to the type of estrogen. The type of progestogen seems to modify the results, since dydrogesterone was associated with reduced CVD risk.
评估绝经激素治疗（MHT）的各种方案及联合用药与临床实践中心血管疾病（CVD）风险之间的关联。
这是一项基于人群的队列研究。
这项基于人群的队列研究使用了健康保险审查与评估服务机构的数据。提取了2011年至2014年期间在全国健康检查中报告≥40岁进入绝经且无CVD病史的女性数据。经过1:1倾向评分匹配后，MHT组和非MHT组共纳入134298对。对参与者进行随访直至2020年12月31日。
在中位随访7.9（四分位间距6.9 - 8.9）年期间，非MHT组和MHT组的CVD发病率分别为每10万人/年146例和每10万人/年179例。在对协变量进行调整后，与非MHT组相比，使用MHT与CVD风险增加相关（风险比[HR]，1.22[1.14 - 1.31]）；该风险基于中风和冠状动脉血运重建风险的增加。替勃龙（HR，1.38，[1.27 - 1.50]）与CVD风险增加相关，但单独使用雌激素或雌激素/孕激素联合用药则不然。无论使用何种雌激素制剂，CVD风险均无差异。对于雌激素/孕激素联合治疗，地屈孕酮与CVD风险降低相关。
MHT使用者患CVD的风险增加。按方案来看，使用替勃龙与CVD风险增加相关，而单独使用雌激素或与孕激素联合使用则不然。根据雌激素类型无差异。孕激素类型似乎会改变结果，因为地屈孕酮与CVD风险降低相关。
