エストロゲンとプロゲスチンと,静脈栓塞のリスク
Mary Cushman1, Lewis H Kuller, Ross Prentice
1Department of Medicine, University of Vermont, Burlington 05446, USA. mary.cushman@uvm.edu
JAMA
|October 7, 2004
まとめ
エストロゲンとプロゲステンの併用による閉経後のホルモン治療は,静脈血栓形成のリスクを2倍にしました. この治療は,また,年齢,肥満,およびファクターVライデン変異に関連したリスクを増幅しました.
科学分野:
- エンドクリノロジー エンドクリノロジー
- 心血管の健康について
- 遺伝学 遺伝学とは
背景:
- 閉経後のホルモン療法は,静脈血栓形成のリスクを増やすことが知られている.
- ホルモン療法と他の血栓形成の危険因子との累積的な効果は不明である.
研究 の 目的:
- 女性の健康イニシアティブのエストロゲン・プラス・プロゲスティン試験による静脈栓塞の発生率に関する最終的なデータを提示する.
- 他のリスク要因の文脈でホルモン療法と静脈栓塞の関連性を調査する.
主な方法:
- 50歳から79歳の閉経後の女性16,608人を対象としたダブルブラインド,ランダム化制御試験です.
- 遺伝子変異を分析したネスド症例対照研究による5.6年間の追跡調査.
- 参加者はコンジュガート馬用エストロゲンとメドロキシプロゲステロンアセテートまたはプラセボを投与された.
主要な成果:
- 静脈栓塞は,ホルモン療法で3.5/1000人年に対して,プラセボで1.7/1000人年 (HR,2.06) で発生しました.
- リスクは年齢 (HR 7.46,70-79歳) とBMI (HR 5.61,肥満女性) に伴って著しく増加した.
- V因子ライデン変異は,ホルモン療法に関連した血栓形成のリスクを顕著に増幅しました (6.69倍増加).
結論:
- エストロゲンとプロゲステンの併用療法では,静脈血栓症のリスクが約2倍になります.
- ホルモン療法は,高齢化,肥満,およびファクターVライデン変異に関連する血栓形成のリスクを悪化させる.
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