Hormone replacement therapy and coronary heart disease in women: A review of the evidence
Hormone replacement therapy and coronary heart disease in women: A review of the evidence
复制标题
DOI：
10.1097/00000441-200210000-00003
复制
发表时间：
2002-10-01
影响因子：
3.1
通讯作者：
Brown, CA
中科院分区：
文献类型：
--
作者：
Low, AK;Russell, LD;Brown, CA
冠心病（CHD）是女性死亡的主要原因，尤其是绝经后女性。激素替代疗法（HRT）在冠心病预防中的作用已被认为多年。早期的流行病学研究表明雌激素具有潜在的心脏保护作用，并指出绝经前女性患冠心病的风险低于男性。后来的观察性研究表明，绝经后妇女接受HRT治疗的冠心病风险降低。到1996年，雌激素（特别是倍美力）是美国分发最多的药物之一。主要的医学组织，如美国内科医师学会和美国妇产科医师学会广泛支持和鼓励HRT降低CHD风险，沿着使用HRT的其他潜在益处（如骨质疏松症预防）。不幸的是，最近的临床试验似乎提出了更多的问题，而不是提供明确的证据，雌激素在冠心病的保护作用。对最近和正在进行的观察性研究和临床试验的回顾可能有助于指导医生推荐和讨论HRT在绝经后妇女中的作用。当这篇文章准备发表时，来自心脏和雌激素/孕激素替代研究随访（HERS II）和妇女健康倡议（WHI）的报告都发表了。两项研究均得出结论，HRT在女性CHD的一级或二级预防中没有作用。
It is well documented that coronary heart disease (CHD) is the leading cause of death in women-especially postmenopausal women. The role of hormone replacement therapy (HRT) in prevention of CHD has been considered for many years. Early epidemiological studies suggested estrogen to have a potential cardioprotective role, noting that premenopausal women have a decreased risk of developing CHD compared with men. Later observational studies showed decrease of CHD risk in postmenopausal women on HRT. By 1996, estrogen (specifically Premarin) was one of the most dispensed medications in the United States. Major medical organizations such as the American College of Physicians and American College of Obstetricians and Gynecologists widely endorsed and encouraged HRT for CHD risk reduction, along with using HRT for other potential benefits (such as osteoporosis prevention). Unfortunately, recent clinical trials seem to raise more questions than provide definitive proof in the protective role of estrogen in CHD. A review of recent and ongoing observational studies and clinical trials may help guide physicians in their recommendation and discussion of the role of HRT in postmenopausal women. As this article was being prepared for publication, reports from both the Heart and Estrogen/Progestin Replacement Study Follow-up (HERS II) and the Women's Health Initiative (WHI) were published. Both studies concluded that HRT has no role in primary or secondary prevention of CHD in women.