更年期荷尔蒙疗法和冠心病:过山车的历史
M Nudy1,2, J Buerger3, S Dreibelbis3
1Division of Cardiology, Heart and Vascular Institute, Penn State Hershey Medical Center, Hershey, PA, USA.
Climacteric : the journal of the International Menopause Society
|December 6, 2023
概括
更年期激素疗法 (HT) 在更年轻的女性中对心血管健康是安全的,在更年期后不久开始治疗. 早期使用HT可能会带来好处,与之前的担忧相反,与适合候选人的当前建议保持一致.
科学领域:
- 心血管科学 心血管科学
- 妇女健康 妇女健康
- 内分泌学 在内分泌学.
背景情况:
- 冠心病 (CHD) 是绝经后妇女死亡的主要原因.
- 更年期激素治疗 (HT) 有效地管理更年期症状,但其心血管影响仍在争论中.
- 包括HERS和WHI在内的相互矛盾的研究结果导致了关于HT和CHD风险的混乱.
研究的目的:
- 审查更年期后女性冠心病 (CHD) 相关的更年期激素治疗 (HT) 使用的历史背景.
- 评估证据支持HT的潜在心脏病益处,特别是当在更年期早期开始时.
- 为适当选择的年轻的绝经后妇女提供HT心血管安全的保证.
主要方法:
- 对更年期荷尔蒙疗法 (HT) 和冠状动脉心脏病 (CHD) 风险的观察,回顾和临床试验数据的审查.
- 对"定时假说"的分析,表明早期HT发起的绝经后对心血管有好处.
- 综合当前的证据,以提供关于HT使用的共识建议的信息.
主要成果:
- 早期的研究表明,使用HT可以改善心血管疾病的益处和生存率.
- 在HERS和WHI研究引入了关于HT的心血管安全的不确定性.
- "时机假设"提出,在更年期开始后不久开始HT可能会给心血管带来好处.
结论:
- 从心血管的角度来看,HT在适当选择的年轻的绝经后妇女中使用时可能是安全的.
- 有证据表明,当HT早期启动时,可能会对心血管有好处,这与"时机假设"一致.
- 目前的共识支持基于时间和个体风险因素在特定人群中明智使用HT.
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