陰道女性荷爾蒙補充可下降停經後女性心臟血管疾病&中風死亡率

Hum Reprod. 2016 Apr;31(4):804-9. doi: 10.1093/humrep/dew014. Epub 2016 Feb 13.

Vaginal estradiol use and the risk for cardiovascular mortality.

Mikkola TS1, Tuomikoski P2, Lyytinen H2, Korhonen P3, Hoti F3, Vattulainen P3, Gissler M4, Ylikorkala O2.

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Abstract

STUDY QUESTION:

Does the use of post-menopausal vaginal estradiol (VE) affect the mortality risk for coronary heart disease (CHD) and stroke.

SUMMARY ANSWER:

The use of VE reduces the risk for cardiovascular mortality.

WHAT IS KNOWN ALREADY:

A growing number of women use VE for post-menopausal genitourinary symptoms. Although this therapy is intended to have only local effects, estrogen is absorbed into the blood circulation and thus VE use may also have systemic effects.

STUDY DESIGN, SIZE, DURATION:

We studied a nationwide cohort in Finland 1994-2009 during which post-menopausal women (n = 195 756) initiated the use of VE (age [mean ± SD] 65.7 ± 10.9 years). Follow-up data gathered 1.4 million women-years and we assessed the mortality risk due to CHD (n= 9656) or stroke (n = 4294).

PARTICIPANTS/MATERIALS, SETTING, METHODS:

The mortality risk in VE users was compared with that in the age-matched background population (standardized mortality ratio; [SMR]; 95% confidence interval) and related to various durations of exposure to VE (1 to ≤3, >3 to ≤5, >5 to ≤10 and >10 years).

MAIN RESULTS AND THE ROLE OF CHANCE:

The use of VE was accompanied by decreases in the risk for CHD and stroke death. The risk reduction for CHD death was highest for >3 to ≤5 years exposure (SMR 0.64; 0.57-0.70) and for stroke for >5 to ≤10 years exposure (SMR 0.64; 0.57-0.72). The risk reductions for both CHD and stroke mortality were detected in all age groups with the highest risk reduction being in women aged 50-59 years (SMR 0.43; 0.19-0.88 and SMR 0.21; 0.06-0.58, respectively).