人附睾分泌蛋在绝经前后女性慢性肾脏疾病患者中的表达水平与疾病相关性研究

目的:探讨人附睾分泌蛋白4(HE4)在绝经前后女性慢性肾脏疾病(CKD)患者中的表达水平及其与疾病分期和肾小球滤过率(eGFR)的相关性。方法:选取2017年1月—2019年6月收治的100例女性CKD患者,其中绝经前37例,绝经后63例。根据eGFR分为CKD 2期26例、CKD 3期42例、CKD 4～5期32例。另选同期健康体检女性50例作为对照组。采用化学发光微粒子免疫检测法检测患者血清中HE4的表达水平,采用脲酶-GLDH偶联速率法检测血清中尿素(Urea)水平,采用MDRD公式计算eGFR,比较绝经前后女性CKD患者中HE4的表达水平,分析HE4与Urea和eGFR的相关性。结果:CKD各期患者HE4水平均高于对照组,差异有统计学意义(P0.05);CKD各期患者绝经后HE4水平均高于绝经前,差异有统计学意义(P0.05);CKD 4～5期组HE4、Urea水平高于CKD 3期组,eGFR水平低于CKD 3期组,差异有统计学意义(P0.05);CKD 3期组HE4、Urea水平高于CKD 2期组,eGFR水平低于CKD 2期组,差异有统计学意义(P0.05),CKD 2期组HE4、Urea水平高于对照组,eGFR水平低于对照组,差异有统计学意义(P0.05);Pearson相关性分析表明,CKD患者HE4水平与eGFR呈负相关(r=-0.622,P0.05),CKD患者HE4水平与Urea呈正相关(r=0.652,P0.05)。结论:CKD患者绝经后HE4表达水平高于绝经前,可用于评价CKD患者的肾脏功能。     

慢性肾脏病患者早期绝经

绝经指的是在排卵停止后月经永久停止。由于激素替代治疗或肾移植术后月经可恢复,所以传统的绝经定义并不适用于慢性肾脏病(CKD)患者。CKD患者绝经年龄提前,普遍认为与下丘脑-垂体-性腺轴破坏有关。绝经常伴随血管舒缩症状,CKD患者血管舒缩症状发生率较低,激素替代治疗可有效缓解症状。与绝经前相比,CKD患者绝经后心血管事件及骨折疏松风险增加。由于缺乏充分的证据,不建议CKD患者使用激素替代治疗预防心血管事件。目前缺乏针对CKD 4～5D期绝经后骨质疏松疗效/不良反应的前瞻性纵向临床试验。     

绝经后冠心病患者的骨密度及其相关因素分析

目的 :探讨绝经后女性冠心病患者骨密度雌二醇 (E2 )变化及其相关因素。　　方法 :研究了 60例绝经后女性冠心病患者 (冠心病组 )Ward’s三角的骨密度 ,雌激素雌二醇及血脂 ,同时以 60例绝经后女性健康人 (对照组 )作对照。　　结果 :冠心病组骨密度较对照组降低 (P <0 0 1)。冠心病组中合并骨质疏松的比例高达 40 %。冠心病组雌二醇较对照组雌二醇降低 (P <0 0 1)。绝经后冠心病患者随着病程增加骨密度降低 ,呈显著负相关 (r=-0 93 ,P <0 0 1)。多因素逐步回归分析提示 ,骨密度与雌二醇呈正相关 (r=0 686,P <0 0 1) ,与甘油三酯 (TG)呈负相关 (r=-5 51,P <0 0 1)。　　结论 :绝经后女性冠心病患者随病程延长其骨密度趋于降低 ,雌激素降低及甘油三酯的增高可能是绝经后女性冠心病及骨质疏松症的共同影响因素     

雌激素水平对绝经后女性急性心肌梗死发生的影响研究

目的:本研究探讨内源性雌激素水平对绝经后女性急性心肌梗死(AMI)发生的影响。方法:本研究共计纳入30例绝经后女性AMI患者(AMI组)和60例健康绝经后女性(对照组)。所有患者均检测内源性性激素水平(包括血雌酮、雌二醇、雄烯二醇和睾酮水平)。多因素Logistic回归分析性激素水平与AMI发生风险的关系。结果:与对照组相比,AMI组的血雌酮、雌二醇、雄烯二醇和睾酮水平明显升高(P0.05),而性激素结合球蛋白(SHBG)水平却减低(P0.05)。单因素Logistic回归分析显示,雌酮、雌二醇、睾酮、臀腰比、体质指数、糖尿病和高血压均与AMI发生呈正相关(P0.05)。校正这些因素后,雌二醇[比值比(OR)4.75,95%可信区间(CI):1.07~21.10,P0.05]和腰臀比(OR=6.46,95%CI:1.09~38.39,P0.05)仍和AMI呈正相关。结论:高雌二醇水平与绝经后女性AMI的发生呈正相关,提示内源性高雌激素可能是绝经后女性AMI发生的独立危险因素。     

绝经后女性ACS患者的临床特点和危险因素分析

目的 探讨绝经后女性急性冠脉综合征(ACS)患者的临床特点及危险因素.方法 回顾性分析2012年1月至2013年12月我院明确诊断为ACS的138例绝经后女性住院患者与259例男性住院患者的临床特点及相关危险因素.结果 ①绝经后女性ACS患者发病年龄大[(62.75±8.62)岁比(56.29±10.20)岁],发病到就诊时间长[(132.30±39.56)h比(105.96±42.01)h],出现典型胸痛症状者较少(女性68.84％,男性81.47％),两组比较差异均有统计意义(P＜0.05).②绝经后女性ACS患者易合并糖尿病、高血压(女性组分别为44.93％、78.99％;男性组分别为22.01％、61.00％),两组比较差异有统计意义(P＜0.05).③绝经后女性ACS患者选择手术治疗(PCI或CABG)者少于男性组(53.62％比66.02％).造影提示女性组重度或闭塞病变较男性组发生率高(54.05％比45.03％),多支病变较男性组发生率高(78.38％比60.82％),两组比较差异有统计意义(P＜0.05).结论 绝经后女性ACS患者发病症状不典型,冠脉病变较重,其范围及严重程度与多项心血管危险因素相关,积极诊治率低,需加强对绝经后女性ACS患者的防治.     

雌孕激素替代治疗与绝经后老年女性结肠直肠癌间关系

妇女健康创议(WHI)研究证实，绝经后女性接受雌孕激素替代治疗将弊大于利，尽管雌孕激素替代治疗可能与绝经后女性罹患结肠直肠癌风险降低有关。本文意就接受雌孕激素替代治疗与绝经后老年女性新发结肠直肠癌危险以及肿瘤相关特征间关系进行了分析。     

绝经前女性首次心肌梗死临床和冠状动脉造影特点分析

目的:探讨绝经前女性首次心肌梗死临床和冠状动脉造影特点。方法:回顾性分析2002-01至2006-12期间,首次患心肌梗死并在发病1个月内行冠状动脉造影的59例绝经前女性(绝经前组)和93例绝经后女性(绝经后组)患者临床和冠状动脉造影特点。结果:绝经前组55.9有高血压;66.7低密度脂蛋白胆固醇≤2.59mmol/L;其总胆固醇[(4.61±1.31)mmol/L]和低密度脂蛋白胆固醇[(2.48±0.90)mmol/L]水平均明显低于绝经后组(P<0.05)。和绝经后组相比,绝经前组有胸痛史者少见,有早发冠心病家族史者多见(P均<0.05);冠状动脉造影显示非阻塞性病变多见,三支病变少见(P均<0.05);18.6的梗死相关血管表现为正常。心肌梗死后心功能及并发症情况绝经前女性和绝经后女性相似。结论:绝经前女性心肌梗死患者危险因素及冠状动脉病变特点和绝经后女性有所不同,应注意早期识别,积极预防。     

骨康胶囊治疗女性绝经后骨质疏松患者189例

<正>绝经后骨质疏松(OP)是绝经后女性的易患疾病之一〔1³〕。本研究观察骨康胶囊治疗女性绝经后OP患者的效果。1资料与方法1.1一般资料2010年1月至2013年1月我院骨科女性绝经后OP患者189例,经X线片检查及骨密度(BMD)测定诊断,年龄453〕。本研究观察骨康胶囊治疗女性绝经后OP患者的效果。1资料与方法1.1一般资料2010年1月至2013年1月我院骨科女性绝经后OP患者189例,经X线片检查及骨密度(BMD)测定诊断,年龄45⁷6〔平均(55.64±7.98)〕岁;病程376〔平均(55.64±7.98)〕岁;病程3⁹年,平均(5.95±1.23)年;自然绝经时间19年,平均(5.95±1.23)年;自然绝经时间1¹0〔平均(6.83±1.83)〕年;     

NAFLD女性患者肝纤维化与绝经时间和雌激素缺乏时间的相关性分析

目的探讨非酒精性脂肪性肝病(NAFLD)女性患者肝纤维化与绝经时间和雌激素缺乏时间的相关性。方法选取安康市中心医院2014年4月—2015年4月收治的84例NAFLD患者纳入研究对象,所有患者依据肝纤维化分期分为A(S1期)、B(S2期)、C(S3期)、D(S4期)四组,其中A组25例,B组22例,C组20例,D组17例。四组患者入院后统计年龄、身体质量指数(BMI)、疾病严重程度、家族史、吸烟史、绝经时间、雌激素缺乏时间各项信息,对比四组绝经时间、雌激素缺乏时间差异,同时以Spearman系数检验女性NAFLD患者绝经时间、雌激素缺乏时间与肝纤维化分期的相关性。结果 A、B、C、D四组患者绝经时间、雌激素缺乏时间对比D组C组B组A组,差异有统计学意义(P0.05)。经相关性分析,女性NAFLD患者绝经时间、雌激素缺乏时间与肝纤维化分期呈正相关,均有(P0.05)。结论绝经期女性NAFLD患者绝经时间、雌激素缺乏时间与肝纤维化呈正相关,能够为绝经期女性NAFLD肝纤维化分期评估提供帮助,应当给予关注。     

绝经前女性冠心病高危因素及冠脉特点

目的探讨绝经前女性高危因素与冠心病(CHD)的发病关系及冠脉造影病变特点。方法选择行冠脉造影检查术的绝经前女性114例和绝经后女性134例。根据冠脉造影结果,将绝经前女性分为CHD组48例(42.1%),年龄(44.1±4.3)岁,共有70支病变冠脉,冠脉正常组66例(57.9%),年龄(44.3±3.8)岁;绝经后女性分为CHD组76例(55%),年龄(58±4.6)岁,共有152支病变冠脉,绝经后冠脉正常组58例(45%),年龄(57±3.8)岁。分析各组临床、冠脉病变特点。结果绝经前女性CHD高血压、糖尿病的患病率明显高于冠脉正常组,绝经后女性CHD组高血压、糖尿病及血脂异常患病率显著高于绝经前女性;绝经前女性患者多为单支血管病变,绝经后女性多为双支及多支血管病变;绝经前女性冠脉病变多<20 mm,绝经后女性冠脉病变多≥20 mm。绝经前女性冠脉病变以左前降支为最常见(70%)。结论高血压及糖尿病是绝经前女性CHD主要发病因素,高甘油三酯是绝经前女性CHD最佳预测因素。绝经前女性CHD患者冠脉病变以单支血管、短病变为主,病变部位多位于前降支。     

雄激素与绝经后女性冠状动脉粥样硬化性心脏病相关研究进展

冠状动脉粥样硬化性心脏病发病率存在着明显的年龄差异,女性在绝经前发病率较低,绝经后迅速增加,几乎达到绝经前的4倍.这种现象提示绝经后女性冠状动脉粥样硬化性心脏病的发生可能与性激素水平的改变有关.近期关于绝经后雄激素水平改变与冠状动脉粥样硬化性心脏病的关系已成为研究的热点,但由于雄激素的确切作用机制较为复杂,所以其对冠状动脉粥样硬化性心脏病的作用仍未完全明确.现就目前雄激素与绝经后女性冠状动脉粥样硬化性心脏病关系的研究进展做一综述,并对雄激素能否用于绝经后女性冠状动脉粥样硬化性心脏病的治疗进行展望.     

Anemia and chronic kidney disease are associated with poor outcomes in heart failure patients

Background

Chronic kidney disease (CKD) has been linked to higher heart failure (HF) risk. Anemia is a common consequence of CKD, and recent evidence suggests that anemia is a risk factor for HF. The purpose of this study was to examine among patients with HF, the association between CKD, anemia and inhospital mortality and early readmission.

Methods

We performed a retrospective cohort study in two Swiss university hospitals. Subjects were selected based the presence of ICD-10 HF codes in 1999. We recorded demographic characteristics and risk factors for HF. CKD was defined as a serum creatinine ≥ 124 956;mol/L for women and ≥ 133 μmol/L for men. The main outcome measures were inhospital mortality and thirty-day readmissions.

Results

Among 955 eligible patients hospitalized with heart failure, 23.0% had CKD. Twenty percent and 6.1% of individuals with and without CKD, respectively, died at the hospital (p < 0.0001). Overall, after adjustment for other patient factors, creatinine and hemoglobin were associated with an increased risk of death at the hospital, and hemoglobin was related to early readmission.

Conclusion

Both CKD and anemia are frequent among older patients with heart failure and are predictors of adverse outcomes, independent of other known risk factors for heart failure.     

Fracture and the risk of coronary events in women with heart disease

BACKGROUND: Osteoporosis is associated with aortic calcification and cardiovascular mortality. However, whether skeletal fractures predict the risk of coronary events is unknown. METHODS: We used Cox proportional hazards models to determine whether postmenopausal fracture was associated with the risk of coronary heart disease events among the 2763 postmenopausal women with known coronary disease enrolled in the Heart and Estrogen/progestin Replacement Study. Because fractures occurred before enrollment (in 615 women) and during follow-up (in 276 women), we treated incident fracture as a time-dependent covariate in our models. RESULTS: During a mean follow-up of 4.1 years, 361 women had coronary heart disease events. The risk of these events was 25% lower in women who sustained fractures than in those without fractures (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.57 to 0.96; P = 0.02). This association was not confounded by physical activity or by factors associated with both fracture and coronary heart disease events (HR = 0.75; 95% CI: 0.57 to 0.98; P = 0.04). CONCLUSION: Postmenopausal women with heart disease who had skeletal fractures had a reduced risk of subsequent coronary events. This unexpected association, if confirmed in future studies, could influence risk-related treatment strategies for cardiovascular disease.     

Hormonal Therapy Increases Arterial Compliance in Postmenopausal Women

Objectives. This study investigated the effects of hormonal therapy on large arterial properties.Background. Arterial stiffness is an emerging risk marker for coronary heart disease and is potentially modifiable. Postmenopausal use of hormonal therapy is associated with a lower risk of coronary heart disease.Methods. Total systemic arterial compliance (SAC) and pulse wave velocity (PWV) were determined in 26 premenopausal and 52 postmenopausal women, 26 of whom were taking hormonal therapy.Results. Arterial compliance was greater in the premenopausal group (mean ± SEM 0.57 ± 0.04 arbitrary compliance units [ACU]) than in the postmenopausal group not taking hormonal therapy (0.26 ± 0.02 ACU, p = 0.001). Postmenopausal women taking hormonal therapy had a significantly increased total SAC compared with women not taking hormonal therapy (0.43 ± 0.02 vs. 0.26 ± 0.02 ACU, p = 0.001). PWV in the aortofemoral region in the premenopausal women was 6.0 ± 0.2 vs. 8.9 ± 0.3 m/s (p < 0.001) in untreated postmenopausal women. However, postmenopausal women taking hormonal therapy had a significantly lower PWV than those not taking hormonal therapy (7.9 ± 0.2 vs. 8.9 ± 0.3 m/s, p = 0.01). Eleven postmenopausal women had their hormone replacement therapy withdrawn for 4 weeks, resulting in a significant decrease in SAC and a significant increase in aortofemoral PWV.Conclusions. The increased SAC and decreased PWV in women receiving hormonal therapy suggest that such therapy may decrease stiffness of the aorta and large arteries in postmenopausal women, with potential benefit for age-related cardiovascular disorders. The reduction of arterial compliance with age appears to be altered with hormonal therapy.     

Diabetes subgroups and risk for complications: The Multi-Ethnic Study of Atherosclerosis (MESA)

AimsTo characterize diabetes subgroups among a multi-ethnic cohort and assess risk for incident complications.MethodsWe included 1587 participants from the Multi-Ethnic Study of Atherosclerosis with diabetes. We characterized eight diabetes subgroups according to absolute thresholds for disease characteristics: age at diabetes diagnosis (≤45 years), fasting glucose (FG ≥7.7 mmol/L; ≥140 mg/dL), and waist circumference (women ≥105 cm; men ≥110 cm). We estimated risk for mortality, incident cardiovascular disease, chronic kidney disease, heart failure, dementia, and retinopathy, respectively, over 17 years after adjustment for demographics, behavioral, clinical risk factors, and cohort attrition.ResultsThe subgroup with both high FG and early age at onset was associated with higher risk for death, CVD, heart failure, CKD, and retinopathy and the subgroup with both early age at onset and high waist circumference was associated CVD, heart failure, CKD, and retinopathy. The subgroup that met all three high-risk thresholds had greater risk for death, heart failure, CKD, and retinopathy. We did not observe evidence for synergistic or antagonistic joint effects of the high-risk characteristics for any outcome.ConclusionsOur work supports differential risk for various diabetes complications among exclusive subgroups defined by age at diabetes onset, fasting glucose, and central adiposity.     

Bone and Kidney Disease: Diagnostic and Therapeutic Implications

Fractures are common in patients with chronic kidney disease (CKD), but the diagnosis and treatment of bone disease in CKD are difficult due to the multiple etiologies of bone disease in these patients. Noninvasive imaging, including bone mineral density by dual energy x-ray absorptiometry, can be useful in diagnosing osteoporosis in predialysis CKD; however, consensus on the diagnosis of osteoporosis among those with advanced CKD—particularly stage 5 CKD patients on dialysis—is lacking. Treatments approved for osteoporosis in postmenopausal women may be used in patients with stage 1 to 3 CKD. Furthermore, post-hoc analyses show efficacy and safety of oral bisphosphonates, raloxifene, and denosumab in stage 4 CKD for short-term treatment. However, treatment decisions are more difficult in stage 5 CKD. Bone biopsy may be required, and most treatments, if used, would be off label. Overall, the diagnosis and treatment of bone disease in patients with CKD require further research.     

Hormone replacement therapy and interrelation between serum interleukin-6 and body mass index in postmenopausal women: a population-based study

Postmenopausal women are at increased risk to develop osteoporosis, coronary artery disease, heart failure, and hypertension. Interleukin-6 (IL-6) may be a pathogenetic element in these disorders. Serum IL-6 levels increase during aging and seem to be related to increased body fat mass. In the present retrospective study we aimed to investigate the role of hormone replacement therapy (HRT) on serum IL-6 levels and the interrelation of IL-6 and body fat mass. Parameters were assessed in a population-based sample of postmenopausal women (n = 302) and, for comparison, 245 men of the same age. Women with HRT (n = 92) had significantly lower serum IL-6 levels compared to subjects without HRT, which was independent of age, antihypertensive therapy, smoking habits, and blood pressure (1.5 +/- 0.1 vs. 2.9 +/- 0.6 pg/mL; P = 0.017). In women without HRT, the body mass index (BMI) was correlated with serum IL-6 levels (P < 0.001). Multivariate analysis controlling simultaneously for the effects of blood pressure and heart rate confirmed the positive correlation (P = 0.001). However, in subjects with HRT no such correlation between IL-6 and BMI was demonstrated, which was confirmed after controlling covariates. In male subjects, BMI correlated with serum IL-6 (P = 0.009), which was, however, blunted after controlling for blood pressure and heart rate, probably indicating an influence of the sympathetic nervous system on this interrelation. In conclusion, women receiving HRT display lower serum IL-6 levels and a blunted interrelation of IL-6 and BMI. As IL-6 may be a pathogenetic factor in age-related diseases, HRT-related inhibition of IL-6 secretion could be an important element for the favorable effects of HRT in postmenopausal women.     

When the At-Risk Do Not Develop Heart Failure: Understanding Positive Deviance Among Postmenopausal African American and Hispanic Women

BackgroundAfrican American and Hispanic postmenopausal women have the highest risk for heart failure compared with other races, but heart failure prevalence is lower than expected in some national cohorts. It is unknown whether psychosocial factors are associated with lower risk of incident heart failure hospitalization among high-risk postmenopausal minority women.Methods and ResultsUsing the Women's Health Initiative Study, African American and US Hispanic women were classified as high-risk for incident heart failure hospitalization with 1 or more traditional heart failure risk factors and the highest tertile heart failure genetic risk scores. Positive psychosocial factors (optimism, social support, religion) and negative psychosocial factors (living alone, social strain, depressive symptoms) were measured using validated survey instruments at baseline. Adjusted subdistribution hazard ratios of developing heart failure hospitalization were determined with death as a competing risk. Positive deviance indicated not developing incident heart failure hospitalization with 1 or more risk factors and the highest tertile for genetic risk. Among 7986 African American women (mean follow-up of 16 years), 27.0% demonstrated positive deviance. Among high-risk African American women, optimism was associated with modestly reduced risk of heart failure hospitalization (subdistribution hazard ratio 0.94, 95% confidence interval 0.91–0.99), and social strain was associated with modestly increased risk of heart failure hospitalization (subdistribution hazard ratio 1.07, 95% confidence interval 1.02–1.12) in the initial models; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses. Among 3341 Hispanic women, 25.1% demonstrated positive deviance. Among high-risk Hispanic women, living alone was associated with increased risk of heart failure hospitalization (subdistribution hazard ratio 1.97, 95% confidence interval 1.06–3.63) in unadjusted analyses; however, no psychosocial factors were associated with heart failure hospitalization in fully adjusted analyses.ConclusionsAmong postmenopausal African American and Hispanic women, a significant proportion remained free from heart failure hospitalization despite having the highest genetic risk profile and 1 or more traditional risk factors. No observed psychosocial factors were associated with incident heart failure hospitalization in high-risk African Americans and Hispanics. Additional investigation is needed to understand protective factors among high-risk African American and Hispanic women.     

慢性肾脏病合并围产期心肌病1例报告附文献复习

摘要： 慢性肾脏病（CKD）合并围产期心肌病(PPCM)的风险很高,预后有别于经典PPCM,研究两者之间关联性有利于积极防控及时干预,对阻止PPCM恶化据有重要意义。通过病例回顾结合文献复习总结CKD及PPCM诊断与治疗进展,根据病史及实验室、影像学检查排除其他心脏疾病。CKD对PPCM发生发展有关,CKD孕妇必须定期进行包括心脏在内的血、尿及影像学孕期检查;发生急慢性心力衰竭者按治疗指南处理相关病情,同时纠正CKD产生的各种不利因素。积极治疗CKD,给予以ACEI（ARB）+β受体阻滞剂或+盐皮质激素受体拮抗剂（MRA）为基础心力衰治疗+靶向治疗可以逆转心脏结构损伤,改善心脏功能及肾功能,提高生存质量,降低死亡率。     

A prospective, observational study of postmenopausal hormone therapy and primary prevention of cardiovascular disease

BACKGROUND: Most primary prevention studies have found that long-term users of postmenopausal hormone therapy are at lower risk for coronary events, but numerous questions remain. An adverse influence of hormone therapy on cardiovascular risk has been suggested during the initial year of use; however, few data are available on short-term hormone therapy. In addition, the cardiovascular effects of daily doses of oral conjugated estrogen lower than 0.625 mg are unknown, and few studies have examined estrogen plus progestin in this regard. OBJECTIVE: To investigate duration, dose, and type of postmenopausal hormone therapy and primary prevention of cardiovascular disease. DESIGN: Prospective, observational cohort study. SETTING: Nurses' Health Study, with follow-up from 1976 to 1996. PATIENTS: 70 533 postmenopausal women, in whom 1258 major coronary events (nonfatal myocardial infarction or fatal coronary disease) and 767 strokes were identified. MEASUREMENTS: Details of postmenopausal hormone use were ascertained by using biennial questionnaires. Cardiovascular disease was established by using a questionnaire and was confirmed by medical record review. Logistic regression models were used to calculate relative risks and 95% CIs, adjusted for confounders. RESULTS: When all cardiovascular risk factors were considered, the risk for major coronary events was lower among current users of hormone therapy, including short-term users, compared with never-users (relative risk, 0.61 [95% CI, 0.52 to 0.71]). Among women taking oral conjugated estrogen, the risk for coronary events was similarly reduced in those currently taking 0.625 mg daily (relative risk, 0.54 [CI, 0.44 to 0.67]) and those taking 0.3 mg daily (relative risk, 0.58 [CI, 0. 37 to 0.92]) compared with never-users. However, the risk for stroke was statistically significantly increased among women taking 0.625 mg or more of oral conjugated estrogen daily (relative risk, 1.35 [CI, 1.08 to 1.68] for 0.625 mg/d and 1.63 [CI, 1.18 to 2.26] for >/=1.25 mg/d) and those taking estrogen plus progestin (relative risk, 1.45 [CI, 1.10 to 1.92]). Overall, little relation was observed between combination hormone therapy and risk for cardiovascular disease (major coronary heart disease plus stroke) (relative risk, 0.91 [CI, 0.75 to 1.11]). CONCLUSIONS: Postmenopausal hormone use appears to decrease risk for major coronary events in women without previous heart disease. Furthermore, 0.3 mg of oral conjugated estrogen daily is associated with a reduction similar to that seen with the standard dose of 0.625 mg. However, estrogen at daily doses of 0.625 mg or greater and in combination with progestin may increase risk for stroke.