Variation in use of menopausal hormone treatment on risk of health outcomes

摘要

cqvip:AIM: To determine the relative risk of selected serious outcomes with variations in use of menopausal hormone treatment(MHT). METHODS: A cohort of 489 women, randomly recruited at age 40-79 years, from a longitudinal study of urbanised population was a study group and was followed for 14 years. Four selected outcomes(coronary artery disease, stroke, peripheral artery disease, breast cancer) were tested. Each woman on entry to the study was interviewed by a dedicated medical practitioner, and data on menstrual and menopausal history and health status were obtained. Outcome information was ascertained by questionnaire and medical reports from attending medical practitioners. In case of death, cause of death was checked with the Registry of Births, Deaths, Marriages and Divorce. This information was available for all women. An ever-user of MHT was defined as use for 6 mo or more at any time during the study. A late start of MHT was defined as 3 years or more from onset of menopause. The generalised linear statistical package was used to examine the data; univariate logistic regression models were used to describe the relationship between patient characteristics and a disease outcome, followed by stepwise multi variate analysis, controlling for age, lifestyle factors and co-morbidities.RESULTS: The risk of ever-use of MHT was significantly increased only for peripheral artery disease(RR = 2.16; 0.99, 4.71; P = 0.05), and not for coronary artery disease, stroke and breast cancer. A late start of MHT(three years or more from onset of menopause) wasassociated with significantly increased risks for coronary artery disease(RR = 2.56; 1.15, 5.72; P = 0.02) and peripheral artery disease(RR = 4.42; 1.55, 12.64; P = 0.005), and use after age 60 years with significantly increased risks for coronary artery disease(RR = 4.98; 2.19, 11.55; P < 0.001), stroke(RR = 2.99; 1.11, 8.08; P = 0.03) and peripheral artery disease(RR = 4.18; 1.24, 14.14; P = 0.02). Use up to 10 years was not associated with significant risk for all outcomes. These risks were confirmed by stepwise multi variate analysis, adjusting for age at recruitment, body mass index, smoking, physical activity and alcohol use, and existing diabetes, mellitus, hypertension and hypercholesterolaemia. Regardless of variations in use, risk for breast cancer was not found. CONCLUSION: The study confirms ever-use of MHT affected only risk of peripheral artery disease; but some use variations could have adverse effects.