在停止随机使用雌激素和孕激素治疗3年后的健康风险和益处
Gerardo Heiss1, Robert Wallace, Garnet L Anderson
1University of North Carolina, School of Public Health, Department of Epidemiology, Chapel Hill, NC 27514-3628, USA. gerardo_heiss@unc.edu
JAMA
|March 6, 2008
概括
雌激素加孕激素的激素治疗在停止干预后没有增加心血管风险. 然而,与安慰剂相比,它导致恶性瘤的风险更高,整体风险增加.
科学领域:
- 生殖医学 生殖医学
- 在瘤学瘤学.
- 心血管医学 心血管医学
背景情况:
- 评估雌激素加孕激素与安慰剂的妇女健康倡议 (WHI) 试验因风险超过益处而提前停止.
- 激素疗法 (HT) 用于更年期症状管理,但其长期安全性需要持续调查.
研究的目的:
- 评估妇女健康倡议 (WHI) 激素治疗干预停止3年后的健康结果.
- 确定结合性马类雌激素 (CEE) 加上美德酸 (MPA) 对主要健康风险的长期影响.
主要方法:
- 从最初的随机,双盲,安慰剂控制的WHI试验中对15730名女性进行了干预后的随访.
- 对主要终点进行半年监测:冠心病和侵袭性乳腺癌.
- 全球指数包括心血管事件,恶性瘤,骨折和死亡率,用于总结风险-收益平衡.
主要成果:
- 干预后,CEE加MPA和安慰剂组之间的心血管事件风险类似.
- 在CEE加MPA组中观察到患恶性瘤 (HR,1.24) 和乳腺癌 (HR,1.27) 的风险显著增加.
- 中东欧和中东欧加MPA组的全因死亡率略高 (HR,1.15),全球风险指数仍然较高 (HR,1.12).
结论:
- 在干预阶段,与CEE加MPA相关的心血管风险增加在停止后没有持续.
- 干预后,CEE加MPA组的恶性瘤风险更高.
- 总体风险益处平衡有利于安慰剂,表明CEE加MPA的风险超过了预防慢性疾病的益处.
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