title: Hormone replacement therapy and risk of atrial fibrillation in Taiwanese menopause women: A nationwide cohort study.
abstract: Hormone replacement therapy (HRT) is associated with risk of vascular disease. The association between atrial fibrillation (AF), vascular events, and different HRTs, including estradiol and conjugated equine estrogens (CEE), has been controversial in previous studies. Thus, we conducted a retrospective cohort study to investigate these associations. Female patients (>45 years old) first diagnosed with menopause were enrolled from National Health Insurance Research Dataset (1998-2008). Cox regression analysis estimated risk of new-onset AF, stroke, and major adverse cardiac events (MACE) after exposure to estradiol or CEE. Of 5489 females (mean age = 55 years) enrolled, 1815 treated with estradiol and 3674 treated with CEE. Incidence per 10(3) person-years of AF, stroke, and MACE in CEE vs estradiol patients was 2.23 vs. 0.92, 14.0 vs. 9.09, and 15.55 vs. 10.47. As compared with patients treated with estradiol, those treated with CEE had a significantly higher incidence of AF, stroke, and MACE. The adjusted hazard ratios for each category were 1.96, 1.30, and 1.26, respectively. The significant results remained similar, even after use of propensity-score-matched strategy. In conclusion, CEE was associated with a higher risk of AF, stroke, and MACE than estradiol in menopausal females. Further exploration of underlying mechanisms is necessary.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan.|Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
authors.forename: Yaw-Bin
authors.initials: YB
authors.lastname: Haung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Hsuan-Fu
authors.initials: HF
authors.lastname: Kuo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Wei-Hua
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Po-Chao
authors.initials: PC
authors.lastname: Hsu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Ho-Ming
authors.initials: HM
authors.lastname: Su
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Tsung-Hsien
authors.initials: TH
authors.lastname: Lin
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Chih-Sheng
authors.initials: CS
authors.lastname: Chu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Shih-Jie
authors.initials: SJ
authors.lastname: Jhuo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Kun-Tai
authors.initials: KT
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Sheng-Hsiung
authors.initials: SH
authors.lastname: Sheu
authors.affiliation: School of Pharmacy, Master Program in Clinical Pharmacy, Kaohsiung Medical University, Kaohsiung 807, Taiwan.|Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.
authors.forename: Chung-Yu
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan.|Department of Public Health, Kaohsiung Medical University, Kaohsiung 807, Taiwan.|Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Ming-Tsang
authors.initials: MT
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Wen-Ter
authors.initials: WT
authors.lastname: Lai
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data; D001281:Atrial Fibrillation / Q000139:chemically induced / Q000208:ethnology / Q000503:physiopathology*; D004958:Estradiol / Q000009:adverse effects; D004966:Estrogens, Conjugated (USP) / Q000009:adverse effects; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008593:Menopause / Q000208:ethnology / Q000502:physiology*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods* / Q000706:statistics & numerical data; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D004966:Estrogens, Conjugated (USP); D004958:Estradiol