Hormone therapy and carotid intima-media thickness: the thick and thin of it.
Hormone therapy and carotid intima-media thickness: the thick and thin of it.
复制标题
激素治疗与颈动脉内膜中层厚度：它的厚与薄。
DOI：
10.1097/gme.0000000000001264
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Merz,CNoelBairey
中科院分区：
文献类型：
--
作者：
Shufelt,ChrisandraL;Merz,CNoelBairey
The timing hypothesis was developed after results from the Women’s Health Initiative (WHI) clinical trials found a trend in lower incidences of cardiovascular disease outcomes in the younger women, closer to the age of natural menopause. 1 Coupled with similar findings from animal and observation studies, this hypothesis proposed that when starting hormone therapy (HT) closer to the age of menopause there may be a beneficial vascular effect in preventing or slowing atherosclerosis while starting later may be harmful. To study this hypothesis, the Kronos Early Estrogen Prevention Study (KEEPS) was designed to assess atherosclerosis progression using imaging markers in recently menopausal women on oral conjugated estrogens, transdermal estradiol, or placebo. Over the 4-year period, the study found early HT did not affect progression atherosclerosis as measured by carotid intima–media thickness (CIMT) between the groups, despite a favorable shift in some cardiovascular risk factors. 2 In addition, all women increased CIMT over time (mean increase of 0.007 mm/y), consistent with agepredicted progression. 2, 3In this recent study, Miller et al 4 evaluated the impact on atherosclerotic progression after stopping HT or placebo in a subgroup of 76 participants from KEEPS using CIMT. Study results found that after a 3-year period of stopping HT there were no accelerated changes in arterial thickness and no differences between treatment groups over time. The authors did note that although there was no difference in progression between groups, for those randomized to oral estradiol, there was a significant increase in CIMT in the posttreatment follow-up compared with the on-treatment years. Yet, overall there was no rebound effect or worsening of the vascular endothelium after stopping hormones.
