| مستخلص: |
Does oestrogen plus progestogen reduce the risk of coronary heart disease (CHD) in postmenopausal women?METHODSDesign: randomised placebo controlled trial.Allocation: {concealed}*.Blinding: blinded {patients, clinicians, data collectors, outcome assessors, and monitoring committee}*.Follow up period: mean 5.6 years.Setting: (40 clinical centres in the US)*.Patients: 16 608 postmenopausal women who were 50-79 years of age (mean age 63 y), had an intact uterus, and resided in the same geographic area for >/=3 years.Interventions: 1 daily tablet of oral conjugated equine oestrogen, 0.625 mg, plus medroxyprogesterone acetate (Prempro, Wyeth Ayerst, Philadelphia, PA, USA), 2.5 mg, (n=8506) or placebo (n=8102). Outcomes: CHID defined as acute myocardial infarction (MI) requiring overnight admission to hospital, death caused by CHD or silent MI identified on serial electrocardiography. Secondary outcomes included coronary revascularisation, confirmed angina, and congestive heart failure.Patient follow up: 94%.*Writing Group for the Women's Health Initiative Investigators. JAMA 2000;288:321-33.MAIN RESULTSAnalysis was by intention to treat. Risk of CHD did not differ for patients who received oestrogen plus progestogen and those who received placebo (table). However, women in the treatment group had an increased risk of CHD during the first year of treatment (hazard ratio 1.81, 95% CI 1.09 to 3.01). The groups did not differ for non-fatal MI (table), death caused by CHD (table), coronary revascularisation, angina, or congestive heart fallure.CONCLUSIONIn postmenopausal women, oestrogen plus progestogen was not cardioprotective and may slightly increase the risk of coronary heart disease, particularly during the first year of treatment.A modified version of this abstract appears in ACP Journal Club. [ABSTRACT FROM AUTHOR] |
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