Cardiovascular health and the menopause: the gynecologist as the patients' interface
Cardiovascular health and the menopause: the gynecologist as the patients' interface
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DOI：
10.1080/13697130600916148
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发表时间：
2006-09-01
期刊：
影响因子：
2.8
通讯作者：
Arias, R. D.
中科院分区：
文献类型：
--
作者：
Arias, R. D.
绝经后雌激素的大幅下降似乎可以解释绝经后妇女心血管疾病（CVD）的急剧增加。妇科医生在这些患者的心血管疾病的诊断、预防和管理中发挥着主要作用；这个角色可能包括对生活方式改变的建议，如果合适的话，开预防性治疗的处方，如激素替代疗法（HRT）和降脂药物。许多观察性研究支持使用雌激素替代疗法（ERT）来预防心血管疾病。然而，最近，大型随机试验给出了意想不到的、相互矛盾的关于HRT对心血管有益的数据，导致混乱，并影响了患者和临床对绝经后HRT作用的看法。这些不同的结果可能是由于HRT方案的差异、入组时的平均年龄和平均绝经时间、治疗持续时间以及观察性研究中的患者选择偏倚。一个与所有研究结果一致的“统一假设”现已被提出：在绝经时开始的HRT可以预防心血管疾病，而在绝经后几年开始的HRT似乎会增加冠心病的发生。这一知识对于妇科医生做出关于使用激素替代疗法的临床决定至关重要。
The large decrease in estrogen following menopause appears to explain the dramatic increase in cardiovascular disease (CVD) in postmenopausal women. Gynecologists are well placed to play a primary role in the diagnosis, prevention and management of CVD in these patients; this role may include advice on lifestyle changes, and, if appropriate, prescribing preventative treatments such as hormone replacement therapy (HRT) and lipid-lowering drugs. The use of estrogen replacement therapy (ERT) to prevent CVD is supported by a number of observational studies. However, recently, large, randomized trials gave unexpected, conflicting data on the cardiovascular benefits of HRT, leading to confusion, and influencing both patient and clinical perceptions regarding the role of HRT postmenopause. These different outcomes may be due to differences in the HRT regimens, mean age and mean time from menopause at enrollment, duration of therapy, and patient selection bias in observational studies. A 'unified hypothesis' consistent with findings from all studies has now been developed: HRT initiated at the time of the menopause prevents CVD, whereas HRT initiated years after the menopause seems to increase CHD events. This knowledge is essential for gynecologists making clinical decisions regarding HRT use.