Grodstein F, Stampfer M J, Colditz G A, Willett W C, Manson J E, Joffe M, Rosner B, Fuchs C, Hankinson S E, Hunter D J, Hennekens C H, Speizer F E
Channing Laboratory, Boston, MA 02115, USA.
N Engl J Med. 1997 Jun 19;336(25):1769-75. doi: 10.1056/NEJM199706193362501.
Postmenopausal hormone therapy has both benefits and hazards, including decreased risks of osteoporosis and cardiovascular disease and an increased risk of breast cancer.
We examined the relation between the use of postmenopausal hormones and mortality among participants in the Nurses' Health Study, who were 30 to 55 years of age at base line in 1976. Data were collected by biennial questionnaires beginning in 1976 and continuing through 1992. We documented 3637 deaths from 1976 to 1994. Each participant who died was matched with 10 controls alive at the time of her death. For each death, we defined the subject's hormone status according to the last biennial questionnaire before her death or before the diagnosis of the fatal disease; this reduced bias caused by the discontinuation of hormone use between the time of diagnosis of a potentially fatal disease and death.
After adjustment for confounding variables, current hormone users had a lower risk of death (relative risk, 0.63; 95 percent confidence interval, 0.56 to 0.70) than subjects who had never taken hormones; however, the apparent benefit decreased with long-term use (relative risk, 0.80; 0.67 to 0.96, after 10 or more years) because of an increase in mortality from breast cancer among long-term hormone users. Current hormone users with coronary risk factors (69 percent of the women) had the largest reduction in mortality (relative risk, 0.51; 95 percent confidence interval, 0.45 to 0.57), with substantially less benefit for those at low risk (13 percent of the women; relative risk, 0.89; 95 percent confidence interval, 0.62 to 1.28).
On average, mortality among women who use postmenopausal hormones is lower than among nonusers; however, the survival benefit diminishes with longer duration of use and is lower for women at low risk for coronary disease.
绝经后激素治疗有其益处和风险，包括降低骨质疏松症和心血管疾病的风险以及增加患乳腺癌的风险。
我们研究了护士健康研究中绝经后激素使用与死亡率之间的关系，这些参与者在1976年基线时年龄为30至55岁。数据从1976年开始每两年通过问卷调查收集一次，一直持续到1992年。我们记录了1976年至1994年期间的3637例死亡病例。每例死亡的参与者与10名在其死亡时仍存活的对照者进行匹配。对于每例死亡病例，我们根据其死亡前或致命疾病诊断前的最后一次两年期问卷调查来确定其激素状态；这减少了因在潜在致命疾病诊断至死亡期间停用激素而导致的偏差。
在对混杂变量进行调整后，当前使用激素的人死亡风险（相对风险为0.63；95%置信区间为0.56至0.70）低于从未使用过激素的人；然而，由于长期使用激素的人患乳腺癌导致的死亡率增加，这种明显的益处随着长期使用而降低（相对风险为0.80；10年或更长时间后为0.67至0.96）。有冠心病风险因素的当前激素使用者（占女性的69%）死亡率降低幅度最大（相对风险为0.51；95%置信区间为0.45至0.57），而低风险者（占女性的13%；相对风险为0.89；95%置信区间为0.62至1.28）受益明显较少。
平均而言，使用绝经后激素的女性死亡率低于未使用者；然而，生存益处会随着使用时间延长而减少，且对于冠心病低风险女性更低。
