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Akter N, Kulinskaya E, Steel N, Bakbergenuly I. The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984-2017. BJOG 2021; 129:994-1003. [PMID: 34773357 PMCID: PMC9298998 DOI: 10.1111/1471-0528.17008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate the effect of estrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46-65 at first prescription. DESIGN Matched cohort study. SETTING Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984-2017). POPULATION 105 199 HRT users (cases) and 224 643 non-users (controls) matched on age and general practice. METHODS Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy, hysterectomy, body mass index, smoking and deprivation status. MAIN OUTCOME MEASURES All-cause mortality. RESULTS A total of 21 751 women died over an average of 13.5 years follow-up per participant, of whom 6329 were users and 15 422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95% CI 0.88-0.94), and in estrogen-only users was 0.99 (0.93-1.07), compared with non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60 and 61-65 years at first treatment were 0.98 (0.92-1.04), 0.87 (0.82-0.92), 0.88 (0.82-0.93) and 0.92 (0.85-0.98) for combined HRT users compared with non-users, and 1.01 (0.84-1.21), 1.03 (0.89-1.18), 0.98 (0.86-1.12) and 0.93 (0.81-1.07) for estrogen-only users, respectively. CONCLUSIONS Combined HRT was associated with a 9% lower risk of all-cause mortality and estrogen-only formulation was not associated with any significant changes. TWEETABLE ABSTRACT Estrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.
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Affiliation(s)
- N Akter
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - E Kulinskaya
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - N Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - I Bakbergenuly
- School of Computing Sciences, University of East Anglia, Norwich, UK
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2
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Stute P, Stadler A, Heufelder A. The impact of menopausal hormone therapy on overall mortality - a comprehensive review. Climacteric 2020; 23:447-459. [PMID: 32552066 DOI: 10.1080/13697137.2020.1767568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Menopausal hormone therapy (MHT) is indicated for menopausal symptom relief. However, MHT has also been shown to be beneficial for prevention of long-term estrogen deficiency sequelae including mortality. Based on a comprehensive literature review on MHT and mortality, the authors' recommendations are as follows: in postmenopausal women, MHT appears to confer a (significant) reduction in overall mortality; the benefit especially applies to women who initiate long-term MHT early after menopause; in women with prevalent cardiovascular risk factors (except for diabetes mellitus, where results are mixed), the benefit of MHT on overall mortality is even more pronounced; and, however, study results are difficult to compare due to heterogeneous study designs.
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Affiliation(s)
- P Stute
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - A Stadler
- Department of Obstetrics and Gynecology, University of Bern, Bern, Switzerland
| | - A Heufelder
- Endocrinology and Metabolism Consultant Service, Paphos, Cyprus
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3
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Oliver-Williams C, Glisic M, Shahzad S, Brown E, Pellegrino Baena C, Chadni M, Chowdhury R, Franco OH, Muka T. The route of administration, timing, duration and dose of postmenopausal hormone therapy and cardiovascular outcomes in women: a systematic review. Hum Reprod Update 2018; 25:257-271. [DOI: 10.1093/humupd/dmy039] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 10/16/2018] [Accepted: 11/07/2018] [Indexed: 12/24/2022] Open
Affiliation(s)
- Clare Oliver-Williams
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Marija Glisic
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sara Shahzad
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | | | - Mahmuda Chadni
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rajiv Chowdhury
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Deputy Minister of Education, Sports and Youth, Ministry of Education, Sports and Youth, Tirana, Albania
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4
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Zhang H, Ta N. Effect of isopsoralen on Smad7 in osteoblastic MC3T3-E1 cells. Exp Ther Med 2017; 14:1561-1567. [PMID: 28810621 PMCID: PMC5526118 DOI: 10.3892/etm.2017.4688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 03/31/2017] [Indexed: 01/17/2023] Open
Abstract
The primary pathological change in postmenopausal osteoporosis (PM-OP) is bone collagen loss caused by estrogen depletion. Osteoblasts synthesize type I collagen, which composes the organic matrix of bone. Although isopsoralen stimulates osteoblastic cell proliferation and differentiation, transforming growth factor (TGF)-β1 is an important cell signaling factor for stimulating collagen synthesis. To explore the association between isopsoralen and the synthesis of collagen in vitro, the molecular and biological association between isopsoralen and TGF-β signaling was examined. (CAGA) 12-luciferase-reporter gene was used to measure TGF-β1 signaling activity. Type I collagen was detected by semiquantitative reverse transcription polymerase chain reaction, and mothers against decapentaplegic homolog 7 (Smad7) protein expression levels were analyzed by western blotting. The expression of collagen in MC3T3-E1 cells stimulated with isopsoralen was significantly upregulated compared with the control groups (P<0.05). Conversely, isopsoralen significantly decreased Smad7 protein expression compared with the control groups (P<0.05). Moreover, it was observed that isopsoralen activates the TGF-β1 signaling pathway and ultimately promotes collagen synthesis through inhibition of Smad7 protein expression. Therefore, isopsoralen is a potential target for the treatment of PM-OP.
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Affiliation(s)
- Huicun Zhang
- Department of Combination of Traditional Chinese and Western Medicine, Beijing Hospital of Traditional Chinese Medicine, Capital University of Medical Sciences, Beijing 100010, P.R. China.,Department of Pathological and Physiological, Beijing Institute of Traditional Chinese Medicine, Beijing 100010, P.R. China
| | - Na Ta
- Department of Public Health and Risk, China National Health Development Research Center, Beijing 100019, P.R. China
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5
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Yu X, Zhou S, Wang J, Zhang Q, Hou J, Zhu L, He Y, Zhao J, Zhong S. Hormone replacement therapy and breast cancer survival: a systematic review and meta-analysis of observational studies. Breast Cancer 2017; 24:643-657. [PMID: 28601917 DOI: 10.1007/s12282-017-0789-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/08/2017] [Indexed: 01/08/2023]
Abstract
Previous studies on the association between hormone replacement therapy (HRT) and breast cancer survival have yielded mixed results. We aimed to perform a meta-analysis to assess the association with all available studies. Relevant studies were identified by searching PubMed and EMBASE to April 2017. We calculated the summary hazard ratios (HRs) and 95% confidence intervals (CIs) using random-effects models. The dose-response relationship was assessed by random-effects meta-analysis and dose-response meta-regression models. Forty cohort studies and two case-control studies involving 1,756,833 participants were included. The results showed that prediagnosis HRT use was associated with decreased risk of dying from breast cancer (HR = 0.88, 95% CI 0.81-0.97) or any cause (HR = 0.79, 95% CI 0.69-0.90). Postdiagnosis HRT use also showed a beneficial effect on breast cancer survival. In the subgroup analyses, we found that patients who were current users at diagnosis or who received combined hormone therapy before diagnosis seemed to show more benefit from HRT use. In dose-response analysis, we observed a linear relationship between prediagnosis HRT and breast cancer-specific mortality and a 1-year increment in duration of exposure to HRT conferred an HR of 0.99 (95% CI 0.98-1.00) for death from breast cancer. In conclusion, the average effect of HRT use seems not harmful to breast cancer survival. Nevertheless, this effect of HRT use is needed for further assessment.
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Affiliation(s)
- Xinnian Yu
- Department of Internal Medicine, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China.,Department of Internal Medicine, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Siying Zhou
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, 210023, China
| | - Jinyan Wang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Qian Zhang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Junchen Hou
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Lingping Zhu
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Yunjie He
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, 210009, China
| | - Jianhua Zhao
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China.,Center of Clinical Laboratory Science, Nanjing Medical University Affiliated Cancer Hospital, Baiziting 42, Nanjing, 210009, China
| | - Shanliang Zhong
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, 210009, China. .,Center of Clinical Laboratory Science, Nanjing Medical University Affiliated Cancer Hospital, Baiziting 42, Nanjing, 210009, China.
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6
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Imtiaz B, Tuppurainen M, Rikkonen T, Kivipelto M, Soininen H, Kröger H, Tolppanen AM. Postmenopausal hormone therapy and Alzheimer disease: A prospective cohort study. Neurology 2017; 88:1062-1068. [PMID: 28202700 PMCID: PMC5384835 DOI: 10.1212/wnl.0000000000003696] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 12/21/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To explore the association between postmenopausal hormone therapy (HT) and Alzheimer disease (AD). METHODS Twenty-year follow-up data from the Kuopio Osteoporosis Risk Factor and Prevention study cohort were used. Self-administered questionnaires were sent to all women aged 47-56 years, residing in Kuopio Province starting in 1989 until 2009, every 5th year. Register-based information on HT prescriptions was available since 1995. Probable AD cases, based on DSM-IV and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria, were identified from the special reimbursement register (1999-2009). The study population included 8,195 women (227 cases of incident AD). RESULTS Postmenopausal estrogen use was not associated with AD risk in register-based or self-reported data (hazard ratio/95% confidence interval 0.92/0.68-1.2, 0.99/0.75-1.3, respectively). Long-term self-reported postmenopausal HT was associated with reduced AD risk (0.53/0.31-0.91). Similar results were obtained with any dementia diagnosis in the hospital discharge register as an outcome. CONCLUSIONS Our results do not provide strong evidence for a protective association between postmenopausal HT use and AD or dementia, although we observed a reduced AD risk among those with long-term self-reported HT use.
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Affiliation(s)
- Bushra Imtiaz
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Marjo Tuppurainen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Toni Rikkonen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Miia Kivipelto
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Hilkka Soininen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Heikki Kröger
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anna-Maija Tolppanen
- From the Institute of Clinical Medicine-Neurology (B.I., M.K., H.S.), Kuopio Musculoskeletal Research Unit, Clinical Research Center (M.T., T.R., H.K.), and Research Center for Comparative Effectiveness and Patient Safety (RECEPS) and School of Pharmacy (A.M.T.), University of Eastern Finland, Kuopio; Department of Obstetrics and Gynecology (M.T.), Neurocenter, Neurology (H.S.), and Department of Orthopedics and Traumatology (H.K.), Kuopio University Hospital, Finland; Department of Medicine (T.R.), University of Cambridge, UK; and Division of Clinical Geriatrics (M.K.), Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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7
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Mikkola TS, Savolainen-Peltonen H, Venetkoski M, Ylikorkala O. New evidence for cardiac benefit of postmenopausal hormone therapy. Climacteric 2017; 20:5-10. [DOI: 10.1080/13697137.2016.1262839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- T. S. Mikkola
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H. Savolainen-Peltonen
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M. Venetkoski
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - O. Ylikorkala
- Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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8
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Hale GE, Shufelt CL. Hormone therapy in menopause: An update on cardiovascular disease considerations. Trends Cardiovasc Med 2015; 25:540-9. [DOI: 10.1016/j.tcm.2015.01.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 01/19/2015] [Accepted: 01/20/2015] [Indexed: 11/28/2022]
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9
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Värri M, Tuomainen TP, Honkanen R, Rikkonen T, Niskanen L, Kröger H, Tuppurainen MT. Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study. Maturitas 2014; 78:304-9. [DOI: 10.1016/j.maturitas.2014.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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10
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Tuomikoski P, Mikkola TS. Postmenopausal hormone therapy and coronary heart disease in early postmenopausal women. Ann Med 2014; 46:1-7. [PMID: 24266727 DOI: 10.3109/07853890.2013.854982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In women, cardiovascular disease (CVD) accounts for about half of all deaths in Western countries. It is generally accepted that endogenous estrogen protects premenopausal women from CVD. However, whether postmenopausal hormone therapy (HT) confers cardiovascular benefit or harm remains controversial. One of the most pronounced factors modifying the cardiovascular effects of HT is age or time since menopause at the initiation of HT. Recently also the impact of hot flushes on CVD risk and the outcomes of HT has gained attention. This review summarizes the newest data regarding HT and CVD in recently postmenopausal women aged 50-59 years in light of the results from older HT trials. The aim is to help clinicians counsel their patients regarding the individual risks and benefits associated with HT use in this age group, where HT use is most prevalent.
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Affiliation(s)
- Pauliina Tuomikoski
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital , Helsinki , Finland
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11
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Ha-Vinh P, Clavaud H, Sauze L. Caractéristiques individuelles et mortalité associées au traitement hormonal substitutif de la ménopause : étude d’une cohorte française de femmes d’âge compris entre 60 et 69 ans. ACTA ACUST UNITED AC 2010; 39:453-65. [DOI: 10.1016/j.jgyn.2010.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Revised: 06/14/2010] [Accepted: 06/16/2010] [Indexed: 10/19/2022]
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12
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Norman SA, Weber AL, Localio AR, Marchbanks PA, Ursin G, Strom BL, Weiss LK, Burkman RT, Bernstein L, Deapen DM, Folger SG, Simon MS, Nadel MR. Hormone therapy and fatal breast cancer. Pharmacoepidemiol Drug Saf 2010; 19:440-7. [PMID: 20336635 PMCID: PMC3098621 DOI: 10.1002/pds.1941] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Among unanswered questions is whether menopausal use of estrogen therapy (ET) or estrogen-plus-progestin therapy (CHT) increases risk of developing fatal breast cancer i.e., developing and dying of breast cancer. Using a population-based case-control design, we estimated incidence rate ratios of fatal breast cancer in postmenopausal hormone therapy (HT) users compared to non-users by type, duration, and recency of HT use. METHODS HT use prior to breast cancer diagnosis in 278 women who died of breast cancer within 6 years of diagnosis (cases) was compared with use in 2224 controls never diagnosed with breast cancer using conditional logistic regression. Measures taken to address potential bias and confounding inherent in case-control studies included collecting and adjusting for detailed data on demographic and other factors potentially associated both with HT use and breast cancer. RESULTS Fifty-six per cent of cases and 68% of controls reported HT use. Among current 3+ year HT users, odds ratios and 95% confidence intervals for death were 0.83 (0.50, 1.38) and 0.69 (0.44, 1.09), respectively, for exclusive use of CHT or of ET, and were 0.94 (0.59, 1.48) and 0.70 (0.45, 1.07) for any use of CHT or of ET regardless of other hormone use. CONCLUSION Point estimates suggest no increased risk of fatal breast cancer with HT use, although 50% increases in risk in longer-term current CHT users cannot be ruled out.
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Affiliation(s)
- Sandra A Norman
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA 19104-6021, USA.
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Pentti K, Tuppurainen MT, Honkanen R, Sandini L, Kröger H, Alhava E, Saarikoski S. Hormone therapy protects from diabetes: the Kuopio osteoporosis risk factor and prevention study. Eur J Endocrinol 2009; 160:979-83. [PMID: 19321660 DOI: 10.1530/eje-09-0151] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The purpose of this population-based prospective cohort study was to examine the effect of hormone therapy (HT) on incidence of diabetes mellitus (DM). DESIGN AND METHODS Eight thousand four hundred and eighty-three DM-free post-menopausal women aged 52-62 from the population-based Kuopio osteoporosis risk factor and prevention study were followed for 5 years from 1994-1999. Information about the use of HT and health events was obtained from three repeated questionnaires in 1989, 1994, and 1999. DM morbidity before and during the follow-up was obtained from the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution. Kaplan-Meyer survival curves and Cox's proportional-hazards models were used to estimate the risk of incident DM in relation to the use of HT. RESULTS During the follow-up, 40.8% DM-free post-menopausal women had never used HT, 27.3% women were HT past users and 31.9% women had used HT presently during the follow-up. During the follow-up, 162 incident DM cases were recorded. Compared with never users of HT, the adjusted hazard ratio of DM was 0.81 (95% confidence interval (CI) 0.57-1.16) for only past users, 0.53 (95% CI 0.24-1.15) in part-time (during the follow-up <2.5 years) users and 0.31 (95% CI 0.16-0.60) in continuous (during the follow-up 2.5-5.0 years) users of HT. CONCLUSIONS HT use decreases the incidence of DM in post-menopausal women.
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Affiliation(s)
- Kati Pentti
- Department of Obstetrics and Gynecology, Kuopio University Hospital, FIN-70211 Kuopio, Finland.
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14
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Agreement of self-reported estrogen use with prescription data: an analysis of women from the Kuopio Osteoporosis Risk Factor and Prevention Study . Menopause 2008; 15:282-9. [PMID: 17998884 DOI: 10.1097/gme.0b013e3181334b6c] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Self-reported data are usually used for the evaluation of the effects of hormone therapy in population studies. We examined the agreement between self-reported hormone therapy use and nationwide prescription data from the Social Insurance Institution of Finland to evaluate the accuracy of self-reports. DESIGN The 10-year questionnaire of the population-based Kuopio Osteoporosis Study was sent in 1999 to 12,562 women aged 57 to 67 years; 11,377 women who completed questionnaires were eligible for analysis. We asked women whether they had been taking estrogen hormone therapy as a gel, plaster, or tablet for the treatment of climacteric symptoms or osteoporosis and if the answer was yes, to specify the brand and duration of treatment for each year from 1994 to 1999. RESULTS Among the 11,377 women, 3,105 (27.3%) reported the use of an estrogen-based preparation in 1996 to 1999, and 97.6% were confirmed by Social Insurance Institution of Finland to have been prescribed hormone therapy during that time. In these women the median duration of use was 32 months (range, 1-41), according to Social Insurance Institution of Finland data. An additional 1,738 women had been prescribed hormone therapy for short periods, but those women did not report it. The duration of self-reported hormone therapy use was compared to the duration of prescriptions. A difference of 3 months or less per year was observed in 63.4% to 77.0% of women during the years 1996-1998. CONCLUSIONS A postal inquiry is a reliable method of recording long-term hormone therapy use.
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15
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Wenger NK. Drugs for cardiovascular disease prevention in women: implications of the AHA Guidelines--2007 Update. Drugs 2008; 68:339-58. [PMID: 18257610 DOI: 10.2165/00003495-200868030-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Lifestyle interventions constitute the initial strategy for the primary and secondary prevention of cardiovascular disease in women. However, pharmacotherapy is often indicated for control of major cardiovascular risk factors, and abundant clinical trial data support the morbidity and mortality benefit of a number of categories of drug therapy following a coronary event. Although women have increasingly been enrolled in clinical trials of pharmacotherapy, under representation of women in most research studies limits the gender-specific assessment of outcomes. Equally importantly, recent randomized clinical trial data have highlighted inappropriate preventive therapies for women (i.e. those lacking effectiveness and potentially imparting harm). Decision-making data for drug therapy for women also derive from a number of clinical trials conducted solely in women. The drug classes reviewed in this article include omega-3 fatty acids, aspirin, ACE inhibitors and angiotensin II receptor antagonists or blockers, beta-adrenoceptor antagonists (beta-blockers), aldosterone antagonists, antioxidants, folic acid and vitamins B(6) and B(12), and menopausal hormone therapy and selective estrogen-receptor modulators. Information is sparse regarding specific cardiovascular pharmacotherapies for elderly women, and women of racial and ethnic minorities. Owing to the under representation of the subset of women in many trials, analysis by age, race and ethnicity is not appropriate. This information gap presents a major challenge for future studies, as these subgroups constitute populations of women at high cardiovascular risk.
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Affiliation(s)
- Nanette K Wenger
- Emory University School of Medicine, Atlanta, Georgia, USAGrady Memorial Hospital, Atlanta, Georgia, USAEmory Heart and Vascular Center, Atlanta, Georgia 30303, USA.
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