Hormone replacement therapy and cardioprotection - What is good and what is bad for the cardiovascular system?
Hormone replacement therapy and cardioprotection - What is good and what is bad for the cardiovascular system?
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DOI：
10.1196/annals.1365.031
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发表时间：
2006-01-01
期刊：
影响因子：
--
通讯作者：
Fini, Massimo
中科院分区：
文献类型：
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作者：
Rosano, Giuseppe M. C.;Vitale, Cristiana;Fini, Massimo
绝经后心血管疾病（CVD）的发病率增加，在任何年龄，绝经后妇女的CVD发病率均显著高于绝经前妇女。一些流行病学研究结果表明，卵巢激素缺乏症在女性CVD的发展中起致病作用。卵巢激素对心血管系统有几种潜在的保护作用，尽管一些观察性研究表明雌激素和雌激素/雌激素相关性对CVD的有益作用，但目前，在随机研究发现后，激素替代疗法（HRT）在预防CVD中的作用仍在争论中。随机研究（心脏和雌激素/孕激素替代研究[HERS]和妇女健康倡议[WHI]）发现，除了关于冠心病（CHD）的不同发现外，与观察性研究的结果基本一致。WHI研究两组之间的差异表明，两个因素，绝经后开始HRT的时间和雌激素/雌激素相关性，对于解释观察性研究和随机临床研究对心血管影响的广泛差异结果至关重要。基础科学和动物研究以及临床调查和临床研究结果一致表明，绝经后很长一段时间与雌激素保护作用的降低有关，而对凝血的不利影响保持不变。在绝经后早期妇女中，与观察性研究中的妇女一样，卵巢激素替代可能具有心脏保护作用，因为内皮细胞对雌激素的反应性也缓冲了凝血时的有害影响。在绝经后期的妇女中，卵巢激素要么无效，要么甚至有害，因为促凝血或斑块不稳定作用优于血管保护作用。因此，HRT在年轻女性中具有有益的心血管效应，而在老年PF女性中，HRT可能对凝血平衡和血管炎症具有不利影响，并且对心血管功能影响不大。
The incidence of cardiovascular diseases (CVDs) increases after menopause and at any age postmenopausal women have a significantly higher incidence of CVD compared to premenopausal women. Several epidemiological findings suggest the causative pathogenetic role of ovarian hormone deficiency in the development of CVD in women. Ovarian hormones have several potential protective effects on the cardiovascular system and despite several observational studies have shown the beneficial effect of estrogens and estrogen/progestin associations on CVD, at the present, after the findings of randomized studies, the effect of hormone replacement therapy (HRT) in the prevention of CVD is still under debate. The randomized studies (Heart and Estrogen/Progestin Replacement Study [HERS] and Women's Health Initiative [WHI]) found largely concordant results with the observational studies except for the divergent findings about coronary heart disease (CHD). The discrepancy between the two arms of the WHI study suggests that two factors, time to initiation of HRT since menopause and estrogen/progestin associations, are of pivotal importance to explain the widely divergent findings on the cardiovascular effects of observational studies and randomized clinical studies. Basic science and animal studies together with clinical investigations and the results of clinical studies are concordant in suggesting that a long time since menopause is associated with a reduced protective effect of estrogens while the unfavorable effects upon coagulation remain unaltered. In early postmenopausal women, like the ones included in the observational studies, ovarian hormone replacement may be cardioprotective because of the responsiveness of the endothelium to estrogens that also buffer the detrimental effects upon coagulation. In late postmenopausal women ovarian hormones have either a null effect or even a detrimental effect because of the predominance of the procoagulant or plaque-destabilizing effects over the vasoprotective effects. Therefore, HRT has beneficial cardiovascular effects in younger women while it may have detrimental effect on coagulative balance and vascular inflammation and has little effect on cardiovascular functions in older PF women.