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Myocardial Infarction and the Use of Estrogen and Estrogen-Progestogen in Postmenopausal Women

Stephen Sidney, MD; Diana B. Petitti, MD; and Charles P. Quesenberry Jr., PhD
[+] Article, Author, and Disclosure Information

From the Kaiser Permanente Medical Care Program, Oakland, California.see end of text. Acknowledgments: The authors thank Teresa Picchi and Luisa Hamilton for overseeing field operations and Kimberly Tolan for computer programming. Grant Support: By grant R01-HL-47043 from the National Heart. Lung, and Blood Institute. Requests for Reprints: Stephen Sidney, MD. Kaiser Permanente Medical Care Program, Division of Research, 3505 Broadway. Oakland, CA 94611-5714. Current Author Addresses: Drs. Sidney and Quesenberry: Kaiser Permanente Medical Care Program. Division of Research, 3505 Broadway, Oakland, CA 94611-5714.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(7):501-508. doi:10.7326/0003-4819-127-7-199710010-00001
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Objective: To estimate the relative risk for incident acute myocardial infarction in relation to the current use of estrogen and estrogen-progestogen.

Design: Retrospective case–control study.

Setting: Medical centers of a large prepaid health care program, the kaiser Permanente Medical Care Program (KPMCP), Northern California region.

Participants: All women hospitalized at a KPMCP center for incident acute myocardial infarction during a 3-year period from 1991 to 1994. Controls were matched to case-patients for year of birth and KPMCP facility and were selected at random from among all female members of the KPMCP.

Intervention: An in-person interview that included questions about current and lifetime use of estrogen and estrogen-progestogen; known cardiovascular risk factors; and other medical, sociodemographic, and behavioral factors that might affect risk for myocardial infarction.

Main Outcome Measure: Odds ratios for myocardial infarction associated with use of estrogen and estrogen-progestogen.

Results: The odds ratio for myocardial infarction in current users of estrogen or estrogen-progestogen compared with women who had never used these agents was 0.96 (95% CI, 0.66 to 1.40) after adjustment for confounders. The odds ratio for myocardial infarction in past users of estrogen or estrogen-progestogen was 1.07 (CI, 0.72 to 1.58). Duration of hormone use was unrelated to the odds ratio for myocardial infarction.

Conclusions: This study did not show a statistically significant decrease in the odds ratio for myocardial infarction associated with current use of estrogen or estrogen-progestogen. It neither confirms nor refutes the hypothesis that hormone use prevents myocardial infarction in postmenopausal women.





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