Use of calcium supplements and the risk of coronary heart disease in 52-62-year-old women: The Kuopio Osteoporosis Risk Factor and Prevention Study.

BACKGROUND: To analyse prospectively the effect of calcium or calcium+D supplementation on coronary heart disease (CHD) in 52-62-year-old women. METHODS AND RESULTS: 10,555 52-62-year-old women from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) who did not have CHD at baseline were followed for nearly 7 years in 1994-2001. Information about use of calcium supplements and health events was obtained from two repeated questionnaires in 1989 and 1994. Information about causes of death during the follow-up was obtained from the Statistics Finland. Information about CHD and other disease morbidity before and during the follow-up was obtained from the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution (SII). Cox's proportional-hazards models were used to estimate the risk of CHD morbidity related to the use of calcium supplements. At baseline, 2723 women reported current use of calcium or calcium+D supplementation. During the follow-up, CHD was diagnosed in 513 women. Compared to non-users of calcium/calcium+D supplements, the multivariate adjusted hazard ratio (HR) of CHD was 1.24 (95% CI 1.02-1.52) in women who used these supplements. The multivariate adjusted HR for CHD morbidity in postmenopausal women who used calcium/calcium+D supplements was 1.26 (95% CI 1.01-1.57). CONCLUSIONS: Calcium or calcium+D supplementation appears to increase the risk of CHD among women before old age.

Hormone therapy protects from diabetes: the Kuopio osteoporosis risk factor and prevention study.

OBJECTIVES: The purpose of this population-based prospective cohort study was to examine the effect of hormone therapy (HT) on incidence of diabetes mellitus (DM). DESIGN AND METHODS: Eight thousand four hundred and eighty-three DM-free post-menopausal women aged 52-62 from the population-based Kuopio osteoporosis risk factor and prevention study were followed for 5 years from 1994-1999. Information about the use of HT and health events was obtained from three repeated questionnaires in 1989, 1994, and 1999. DM morbidity before and during the follow-up was obtained from the Registry of Specially Refunded Drugs of the Finnish Social Insurance Institution. Kaplan-Meyer survival curves and Cox's proportional-hazards models were used to estimate the risk of incident DM in relation to the use of HT. RESULTS: During the follow-up, 40.8% DM-free post-menopausal women had never used HT, 27.3% women were HT past users and 31.9% women had used HT presently during the follow-up. During the follow-up, 162 incident DM cases were recorded. Compared with never users of HT, the adjusted hazard ratio of DM was 0.81 (95% confidence interval (CI) 0.57-1.16) for only past users, 0.53 (95% CI 0.24-1.15) in part-time (during the follow-up <2.5 years) users and 0.31 (95% CI 0.16-0.60) in continuous (during the follow-up 2.5-5.0 years) users of HT. CONCLUSIONS: HT use decreases the incidence of DM in post-menopausal women.

Agreement of self-reported estrogen use with prescription data: an analysis of women from the Kuopio Osteoporosis Risk Factor and Prevention Study .

OBJECTIVE: Self-reported data are usually used for the evaluation of the effects of hormone therapy in population studies. We examined the agreement between self-reported hormone therapy use and nationwide prescription data from the Social Insurance Institution of Finland to evaluate the accuracy of self-reports. DESIGN: The 10-year questionnaire of the population-based Kuopio Osteoporosis Study was sent in 1999 to 12,562 women aged 57 to 67 years; 11,377 women who completed questionnaires were eligible for analysis. We asked women whether they had been taking estrogen hormone therapy as a gel, plaster, or tablet for the treatment of climacteric symptoms or osteoporosis and if the answer was yes, to specify the brand and duration of treatment for each year from 1994 to 1999. RESULTS: Among the 11,377 women, 3,105 (27.3%) reported the use of an estrogen-based preparation in 1996 to 1999, and 97.6% were confirmed by Social Insurance Institution of Finland to have been prescribed hormone therapy during that time. In these women the median duration of use was 32 months (range, 1-41), according to Social Insurance Institution of Finland data. An additional 1,738 women had been prescribed hormone therapy for short periods, but those women did not report it. The duration of self-reported hormone therapy use was compared to the duration of prescriptions. A difference of 3 months or less per year was observed in 63.4% to 77.0% of women during the years 1996-1998. CONCLUSIONS: A postal inquiry is a reliable method of recording long-term hormone therapy use.

Hormone replacement therapy and mortality in 52- to 70-year-old women: the Kuopio Osteoporosis Risk Factor and Prevention Study.

OBJECTIVES: To analyze prospectively the association between hormone replacement therapy (HRT) and mortality in women before old age. DESIGN AND METHODS: A group of 11,667 women (91% of the age cohort of the area) aged 52-62 years from the population-based Kuopio Osteoporosis Risk Factor and Prevention Study were followed for 7 years in 1994-2001. Information about HRT use and health events was obtained from two repeated questionnaires in 1989 and 1994. Information about deaths and causes of death from the follow-up period was obtained from the Statistics Finland. Cox's proportional-hazards models were used to calculate risk of death related to the use of HRT. RESULTS: At the start of follow-up, 2203 women had used HRT > 5 years, 3945 women < or = 5 years and 5519 women had never used it. During the follow-up, 361 deaths occurred. Compared with non-users of HRT, the adjusted hazard ratio (HR) of death from any cause was 1.05 (95% confidence interval (CI) 0.80-1.36) in women who used HRT < or = 5 years and 1.06 (95% CI 0.78-1.46) in women who used HRT > 5 years. The adjusted HR for coronary heart disease (CHD) mortality in women who used HRT < or = 5 years was 0.79 (95% CI 0.36-1.73), and in women who used HRT > 5 years, 2.16 (95% CI 0.93-4.98). For breast cancer mortality the adjusted HR for < or = 5 years of HRT use was 0.96 (95% CI 0.32-2.82) and 2.62 (95% CI 0.98-7.00) for > 5 years of HRT use. CONCLUSIONS: History of HRT use does not affect overall or CHD mortality in women. More than 5 years of HRT use may increase the risk of breast cancer mortality.