エストラディオール療法とプロゲステロンとエンドセリウム依存性血管拡張を併用して,閉経後の女性におけるエストラディオール療法
M Gerhard1, B W Walsh, A Tawakol
1Department of Medicine, Obstetrics and Gynecology , Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Circulation
|September 22, 1998
まとめ
エストロゲン置換療法は,閉経後の女性の血管機能を改善します. プロゲステロンの追加は,内皮機能やコレステロールレベルに対するエストロゲンの利点をブロックしません.
科学分野:
- 心血管科学 心血管科学
- エンドクリノロジー エンドクリノロジー
- 女性の健康 女性の健康
背景:
- 流行病学的な研究は,エストロゲン置換療法 (ERT) が閉経後の女性の心血管疾患を減少させることを示唆しています.
- エストロゲンの心血管に対する保護は,内皮機能の改善と血管拡張から生じる可能性があります.
- エストロゲンの血管効果に対するプロゲステロンの影響は十分に理解されていません.
研究 の 目的:
- 経皮エストラディオールが,マイクロ化プロゲステロンを含めたり含まないかによって,閉経後の女性における内皮に依存する血管拡張に対する効果を調査する.
- プロゲステロンがエストロゲンの有益な血管効果を弱めるかどうかを判断する.
主な方法:
- 軽度の高コレステロール血症を持つ17人の閉経後の女性を対象としたプラセボ対照クロスオーバー試験.
- 高解像度Bモード超音波検査で,腕動脈の直径を測定しました.
- 内皮に依存する血管拡張は,反応性高血症によって評価され,内皮に依存しない血管拡張は,ニトログリセリンを用いて評価された.
主要な成果:
- エストラディオールは,内皮に依存した血管拡張を有意に改善しました (プラセボでは4.7%に対して11.1%の変化,P<0.001).
- プロゲステロンは,この改善を有意に弱めませんでした; 併用療法では,9.6%の血管拡張が示されました (P=NS vs. エストラディオール単独).
- エストラディオールは,プロゲステロンと併用しても,総コレステロールとLDLコレステロールをわずかに低下させた (P<0.001対プラセボ).
結論:
- マイクロ化されたプロゲステロンは,内皮に依存した血管拡張に対するエストラディオルのポジティブな影響を軽減しません.
- ホルモン置換療法の血管保護効果は,脂質低下効果を超えて広がる可能性があります.
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