Schairer C, Adami H O, Hoover R, Persson I
Environmental Epidemiology Branch, National Cancer Institute, Rockville, MD 20892-7374, USA.
Epidemiology. 1997 Jan;8(1):59-65. doi: 10.1097/00001648-199701000-00010.
To assess the risks and benefits of menopausal hormone replacement therapy, we followed a 23,346-member, population-based cohort of Swedish women who were prescribed menopausal estrogens for an average of 8.6 years for mortality. Compared with the general population, the standardized mortality ratio for all-cause mortality in this cohort was 0.77 (95% confidence limits = 0.73, 0.81). Deaths in each of the 12 major categories of causes of death except for injuries occurred 12% to 86% less frequently than expected. We examined in detail four specific causes of death according to the type of hormone prescribed, namely weak estrogens (primarily estriol), more potent estrogens (primarily estradiol and conjugated estrogens) in combination with a progestin, and more potent estrogens without a progestin. Mortality from endometrial cancer was not related to the prescription of weak estrogens or an estrogen-progestin combination, but mortality was 40% higher in women prescribed more potent estrogens without a progestin. Women prescribed weak estrogens, more potent estrogens, and the combined estrogen-progestin regimen were at reduced risk of death from ischemic heart disease (standardized mortality ratios of 0.7, 0.6, and 0.4, respectively). The more potent estrogens and the estrogen-progestin combination were associated with a marked reduction in risk of intracerebral hemorrhage (standardize mortality ratios of 0.4 and 0.6, respectively) and "other" cerebrovascular disease, but not other types of stroke. The concern that use of progestins would lead to psychic disorders related to suicide received no support from our results. Breast cancer results are described elsewhere. These data provide little evidence of an adverse effect of the combined estrogen-progestin regimen as compared with estrogens alone on mortality. They do indicate, however, that both selection factors and biology may contribute to the almost across-the-board-reduction in mortality associated with hormone replacement therapy.
为评估绝经后激素替代疗法的风险与益处，我们对一个基于人群的、由23346名瑞典女性组成的队列进行了随访。这些女性平均接受了8.6年的绝经后雌激素治疗，以观察死亡率。与普通人群相比，该队列全因死亡率的标准化死亡比为0.77（95%置信区间 = 0.73, 0.81）。除伤害外的12种主要死因中，每种死因的死亡发生率均比预期低12%至86%。我们根据所开激素的类型详细研究了四种特定死因，即弱雌激素（主要是雌三醇）、与孕激素联合使用的更强效雌激素（主要是雌二醇和结合雌激素）以及不与孕激素联合使用的更强效雌激素。子宫内膜癌死亡率与弱雌激素或雌激素 - 孕激素联合用药无关，但在使用不与孕激素联合的更强效雌激素的女性中，死亡率高出40%。接受弱雌激素、更强效雌激素以及雌激素 - 孕激素联合治疗方案的女性死于缺血性心脏病的风险降低（标准化死亡比分别为0.7、0.6和0.4）。更强效雌激素和雌激素 - 孕激素联合用药与脑出血风险（标准化死亡比分别为0.4和0.6）及“其他”脑血管疾病的显著降低相关，但与其他类型的中风无关。关于使用孕激素会导致与自杀相关的精神障碍这一担忧，我们的结果并未提供支持。乳腺癌结果在其他地方描述。与单独使用雌激素相比，这些数据几乎没有提供雌激素 - 孕激素联合治疗方案对死亡率有不良影响的证据。然而，它们确实表明，选择因素和生物学因素可能都有助于激素替代疗法几乎全面降低死亡率。
