Postmenopausal hormones and coronary artery disease: potential benefits and risks
Postmenopausal hormones and coronary artery disease: potential benefits and risks
复制标题
绝经后激素和冠状动脉疾病：潜在的益处和风险
作者：
R. Lobo
各种二级预防试验，包括评估激素治疗 (HT) 对冠状动脉疾病 (CAD) 影响的妇女健康倡议 (WHI0)，均未显示任何益处，并且有早期危害的趋势。然而，在 WHI 试验中，CAD 存在随时间推移而降低的显着趋势。WHI 中雌激素和雌激素/孕激素的观察组得出的结果与早期观察性研究中报告的心脏保护作用相似。这些观察性试验中的女性在更年轻的时候就开始使用激素随机试验中，基于对 7000 多名早期绝经后女性进行激素使用的前瞻性试验的报告，对 50-59 岁年龄组的分析显示，没有发现任何表明早期伤害的证据。冠状动脉事件近乎统计性下降：63（0.36-1.08），总体冠状动脉评分显着降低 0.66（0.45-0.96）。在对 23 项激素治疗随机临床试验的汇总分析中，绝经 10 年内的女性冠状动脉事件显着减少，为 0.68（0.48-0.96）。由于阿司匹林和他汀类药物均未显示出对降低 CAD 具有统计学上的主要益处，因此对于年轻女性而言，雌激素的益处仍然具有吸引力但尚未得到证实。 总之，虽然很明显 HT 在治疗患有 CAD 的老年女性中没有作用，但新出现的证据强烈表明，对于年轻健康女性来说，HT 可能具有冠状动脉益处。
Various secondary prevention trials, including the Women's Health Initiative (WHI0, assessing the effects of hormone therapy (HT) on coronary artery disease (CAD) showed no benefit, and a trend towards early harm. However, in the WHI trial, there was a significant trend for decreasing CAD with time. The observational arms of WHI for both estrogen and estrogen/progestin suggested results which were similar to the cardioprotective effects reported in earlier observational studies. Women in these observational trials initiated hormones at a younger age and were generally healthier than women in the randomized trials. Hypotheses have been generated to explain the phenomenon of early harm, based on the induction of plaque instability in the older woman with existent significant atherosclerosis. A report of over 7000 early postmenopausal women initiating prospective trials on hormonal use did not find any evidence suggesting early harm. In the estrogen-only arm of the WHI trial, an analysis of the 50–59-year-old age group showed a near statistical decrease in coronary events: 63 (0.36–1.08), and a statistically significant reduction in a global coronary score, 0.66 (0.45–0.96). In a pooled analysis of 23 randomized clinical trials of hormonal therapy, those women within 10 years of menopause had a significant reduction in coronary events, 0.68 (0.48–0.96). Recent publications from WHI have shown a significant trend for reduced CAD and total mortality in younger women, as well as a reduced coronary calcium score when estrogen alone was given. In that neither aspirin nor statins have been shown to afford a statistical primary benefit for reducing CAD, the benefit of estrogen remains an attractive yet unproven possibility for younger women. In conclusion, while it is clear that HT has no place in the treatment of older women with CAD, emerging evidence strongly suggests a possible coronary benefit in younger healthy women.
影响因子：
5.3
作者：
Juliana Hwang;W. Mack;Min Xiang;A. Sevanian;R. Lobo;H. Hodis
通讯作者：
Juliana Hwang;W. Mack;Min Xiang;A. Sevanian;R. Lobo;H. Hodis