Kaplan R C, Heckbert S R, Weiss N S, Wahl P W, Smith N L, Newton K M, Psaty B M
Cardiovascular Health Research Unit, University of Washington, Seattle 98101, USA.
Diabetes Care. 1998 Jul;21(7):1117-21. doi: 10.2337/diacare.21.7.1117.
The effect of hormone replacement therapy on the risk of myocardial infarction in diabetic women has not been well studied. We conducted a case-control study of postmenopausal estrogen use and risk of incident myocardial infarction (MI) in pharmacologically treated diabetic women enrolled at Group Health Cooperative of Puget Sound, a large health maintenance organization in the state of Washington.
Case subjects (n = 212) were all postmenopausal women with treated diabetes who sustained an incident fatal or nonfatal MI between July 1986 and December 1994. Control subjects (n = 122) were treated diabetic women drawn from a stratified random sample of postmenopausal women without prior MI. Computerized pharmacy data and medical records were used to measure use of estrogens. Cardiovascular risk factors recorded from medical records, computerized pharmacy and laboratory data, and telephone interviews were used as adjustment variables.
In this study 8.5% of case and 13.9% of control subjects were current users of estrogens. The relative risk (RR) of MI for current estrogen users was 0.51 (95% CI 0.22-1.15) relative to never users, adjusted for age, study year, weight, angina, and duration of treated diabetes. Among current estrogen users, risk of MI tended to decline with each additional year of estrogen use (adjusted RR = 0.78, 95% CI 0.56-1.08). Of those studied, 45.3% of case and 37.7% of control subjects were past users of estrogens (adjusted RR = 1.22, 95% CI 0.71-2.09).
This study suggests that use of postmenopausal estrogens does not increase risk of MI in diabetic women and that sustained use may be of benefit.
激素替代疗法对糖尿病女性心肌梗死风险的影响尚未得到充分研究。我们在华盛顿州一家大型健康维护组织普吉特海湾健康合作社登记的接受药物治疗的糖尿病女性中，开展了一项关于绝经后雌激素使用与首次发生心肌梗死（MI）风险的病例对照研究。
病例组（n = 212）为1986年7月至1994年12月期间发生首次致命或非致命性心肌梗死的所有接受治疗的绝经后糖尿病女性。对照组（n = 122）为从无既往心肌梗死的绝经后女性分层随机样本中选取的接受治疗的糖尿病女性。利用计算机化药房数据和医疗记录来衡量雌激素的使用情况。从医疗记录、计算机化药房和实验室数据以及电话访谈中记录的心血管危险因素用作调整变量。
在本研究中，8.5%的病例组和13.9%的对照组为当前雌激素使用者。在对年龄、研究年份、体重、心绞痛和糖尿病治疗时长进行调整后，当前雌激素使用者发生心肌梗死的相对风险（RR）相对于从未使用者为0.51（95%可信区间0.22 - 1.15）。在当前雌激素使用者中，心肌梗死风险倾向于随着雌激素使用年限的增加而降低（调整后的RR = 0.78，95%可信区间0.56 - 1.08）。在这些研究对象中，45.3%的病例组和37.7%的对照组为既往雌激素使用者（调整后的RR = 1.22，95%可信区间0.71 - 2.09）。
本研究表明，绝经后雌激素的使用不会增加糖尿病女性发生心肌梗死的风险，持续使用可能有益。
