Postmenopausal hormone replacement therapy and atherosclerosis.
Postmenopausal hormone replacement therapy and atherosclerosis.
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DOI：
10.1007/s11883-002-0077-4
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发表时间：
2002-09-01
影响因子：
5.8
通讯作者：
Mosca, Lori
中科院分区：
文献类型：
--
作者：
Ho, Jennifer E;Mosca, Lori
自从雌激素被首次提出具有血管保护作用以来，绝经后激素替代疗法(HRT)在预防心血管疾病(CVD)中的作用已经演变。涉及血管细胞雌激素受体的新的分子信号通路的发现和众多生物学机制的阐明表明，HRT可能通过多个机制发挥其潜在的有益或不利的心血管效应。雌激素既具有基因组效应，也具有快速非基因组效应，可改变血管扩张、凝血、炎症和血管损伤反应，其中一些可能具有潜在的有益或不利的心血管后果。目前的指南不支持在心血管疾病的二级预防中使用激素替代疗法，最近的一级预防试验结果表明，雌激素和孕激素的联合治疗增加了早期心血管风险，并且没有整体健康益处。雌激素单独在心血管疾病一级预防中的作用有待正在进行的试验结果。使用雌激素替代疗法预防心血管疾病的关键可能是在动脉粥样硬化明显之前进行靶向治疗，并识别具有遗传易感性的女性，她们可能面临与治疗相关的不良结果的更高风险。
The role of postmenopausal hormone replacement therapy (HRT) in the prevention of cardiovascular disease (CVD) has evolved since estrogen was first proposed to be vasoprotective. The discovery of novel molecular signaling pathways involving the estrogen receptor in vascular cells and the elucidation of numerous biologic mechanisms have suggested that HRT may exert its potentially beneficial or adverse cardiovascular effects through multiple mechanisms. Estrogen has genomic, as well as rapid nongenomic, effects that alter vasodilation, coagulation, inflammation, and the vascular injury response, some of which may have potentially beneficial or adverse cardiovascular consequences. Current guidelines do not support the use of HRT in the secondary prevention of CVD, and recent results of primary prevention trials show evidence of increased early cardiovascular risk and no overall health benefit with combination estrogen-progestin treatment. The role of estrogen alone in the primary prevention of CVD awaits the results of ongoing trials. The key to the use of estrogen replacement therapy for the prevention of CVD may be to target therapy before atherosclerosis is evident, and to identify women with genetic susceptibility who may be at increased risk for an adverse outcome associated with therapy.