本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.6542

摘要内容如下：

重要性

美国约有5500万人，全世界约有11亿人是绝经后妇女。为了让临床实践了解绝经期激素治疗、钙加维生素D补充剂和低脂肪饮食模式对健康的影响，妇女健康倡议（WHI）从1993年至1998年招募了161808名50至79岁的绝经后美国妇女（临床试验中n=68132），并对她们进行了长达20年的随访。

观察

WHI临床试验结果不支持绝经后妇女使用口服结合马雌激素联合醋酸甲羟孕酮进行激素治疗，或单独使用结合马雌激素进行子宫切除术以预防心血管疾病、痴呆或其他慢性疾病。然而，激素疗法对治疗中度至重度血管舒缩和其他更年期症状有效。绝经早期激素治疗的这些益处，加上与绝经晚期相比，绝经早期激素治疗的不良反应发生率较低，支持没有激素治疗禁忌症但有令人烦恼的绝经症状的妇女在60岁之前开始激素治疗。WHI结果并不支持在所有绝经后妇女中常规推荐钙加维生素D补充剂预防骨折。然而，钙和维生素D对于那些不符合国家饮食指南中推荐摄入这些营养素的女性来说是合适的。增加水果、蔬菜和谷物摄入的低脂饮食模式并不能预防乳腺癌或结直肠癌的主要转归，但在长期随访期间与乳腺癌死亡率的次要转归的较低发生率相关。

结论和相关性

对于绝经后妇女，WHI随机临床试验不支持通过绝经期激素治疗来预防心血管疾病或其他慢性疾病。绝经期激素疗法适用于治疗更年期早期妇女令人烦恼的血管舒缩症状，无禁忌症，对激素疗法感兴趣。妇女健康倡议的证据并不支持更年期妇女常规补充钙加维生素D以预防骨折，或增加水果、蔬菜和谷物的低脂饮食以预防乳腺癌或结直肠癌。低脂肪饮食模式在降低乳腺癌死亡率方面的潜在作用（次要结果）值得进一步研究。

英文原文如下：

Abstracts

Importance  Approximately 55 million people in the US and approximately 1.1 billion people worldwide are postmenopausal women. To inform clinical practice about the health effects of menopausal hormone therapy, calcium plus vitamin D supplementation, and a low-fat dietary pattern, the Women's Health Initiative (WHI) enrolled 161 808 postmenopausal US women (N = 68 132 in the clinical trials) aged 50 to 79 years at baseline from 1993 to 1998, and followed them up for up to 20 years.

Observations  The WHI clinical trial results do not support hormone therapy with oral conjugated equine estrogens plus medroxyprogesterone acetate for postmenopausal women or conjugated equine estrogens alone for those with prior hysterectomy to prevent cardiovascular disease, dementia, or other chronic diseases. However, hormone therapy is effective for treating moderate to severe vasomotor and other menopausal symptoms. These benefits of hormone therapy in early menopause, combined with lower rates of adverse effects of hormone therapy in early compared with later menopause, support initiation of hormone therapy before age 60 years for women without contraindications to hormone therapy who have bothersome menopausal symptoms. The WHI results do not support routinely recommending calcium plus vitamin D supplementation for fracture prevention in all postmenopausal women. However, calcium and vitamin D are appropriate for women who do not meet national guidelines for recommended intakes of these nutrients through diet. A low-fat dietary pattern with increased fruit, vegetable, and grain consumption did not prevent the primary outcomes of breast or colorectal cancer but was associated with lower rates of the secondary outcome of breast cancer mortality during long-term follow-up.

Conclusions and Relevance  For postmenopausal women, the WHI randomized clinical trials do not support menopausal hormone therapy to prevent cardiovascular disease or other chronic diseases. Menopausal hormone therapy is appropriate to treat bothersome vasomotor symptoms among women in early menopause, without contraindications, who are interested in taking hormone therapy. The WHI evidence does not support routine supplementation with calcium plus vitamin D for menopausal women to prevent fractures or a low-fat diet with increased fruits, vegetables, and grains to prevent breast or colorectal cancer. A potential role of a low-fat dietary pattern in reducing breast cancer mortality, a secondary outcome, warrants further study.

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