Hormone Replacement Therapy, Prothrombotic Mutations, and the Risk of Incident Nonfatal Myocardial Infarction in Postmenopausal Women

摘要: ContextEstrogens are known to be prothrombotic, and findings from the Heart and Estrogen/progestin Replacement Study suggest that in women with clinically recognized heart disease, hormone replacement therapy (HRT) may associated with early harm late benefit terms of coronary events.ObjectiveTo assess whether, as hypothesized, prothrombotic mutations modify the association between HRT use incidence first myocardial infarction (MI).Design SettingPopulation-based, case-control study conducted a Seattle-based health maintenance organization.ParticipantsCases were 232 postmenopausal aged 30 79 years who had their first nonfatal MI 1995 1998. Controls stratified random sample 723 without frequency-matched to cases by age, calendar year, hypertension status.Main Outcome MeasureRisk based on current presence or absence coagulation factor V Leiden prothrombin 20210 G→A variants among cases controls, hypertension.ResultsOne hundred eight 387 controls 124 MI 336 did not. Among hypertensive women, prothrombin variant was risk for (odds ratio [OR], 4.32; 95% confidence interval [CI], 1.52-12.1) and, this stratum, there also significant interaction between presence variant MI. Compared nonusers wild-type genotype, current users (n = 8) nearly 11-fold increase in (OR, 10.9; CI, 2.15-55.2). The interaction with the more pronounced analyses assuming 100% compliance than those 80% compliance HRT. absent among nonhypertensive less if nonhypertensive women combined into 1 group. No found Leiden in either or women. women, the estimates affected only trivial ways adjustment, interaction with specific HRT.ConclusionsOur results among differed without the variant. If these confirmed in other studies, screening permit better assessment of risks benefits associated