POSTMENOPAUSAL HORMONE THERAPY--RISKS AND BENEFITS

冠状动脉疾病（CAD）和骨质疏松症是两种主要的 绝经后妇女的医疗问题。 而 雌激素/孕激素替代疗法推荐用于 预防骨质流失，雌激素和孕激素 对许多CAD风险具有重要且通常相反的影响， 因素 我们建议进行全面综合的三年评估 九种不同治疗策略对骨量的影响 滞留、子宫内膜状态、胆结石形成和一些 CAD风险因素，与一组可比的 对照 实验组仅包括三种雌激素 组（仅限女性）和6个 雌激素/孕激素组评估剂量、模式的影响 给药方式、孕激素类型和激素时间 在这些参数上。 这项研究不仅将确定对CAD风险因素的影响， 包括脂蛋白（VLDL、LDL、HDL和HDL亚组分， HDL 2/3）和载脂蛋白（apoA-I、A-II、B）水平，空腹和 攻毒后血糖水平、许多凝血参数 包括凝血、纤溶和血小板指标 聚集和血压，但也对潜在的重要 脂蛋白组成的变化。 我们还将 检查对LDL颗粒密度分布的影响， 研究亚组中LDL的水平和组成 人口 拟议研究的结果将提供 信息，以便就如何界定 策略提供了最佳的保护，防止骨质流失， 子宫内膜增生，但对有益的 雌激素对心血管的影响

Coronary artery disease (CAD) and osteoporosis are two primary medical problems in post menopausal women. While estrogen/progestogen replacement therapy is recommended for prevention of bone loss, estrogens and progestogens have important and often opposing effects on a number of CAD risk factors. We propose a comprehensive and integrated three year evaluation of the effects of nine different treatment strategies on bone mass retention, endometrial status, gallstone formation and a number of CAD risk factors, as compared with a group of comparable controls. Experimental groups will include three estrogen only groups (hysterectomized women only), and six estrogen/progestogen groups to evaluate effects of dosage, mode of administration, type of progestogen and timing of hormonal administration on these parameters. The study will not only establish the effects on CAD risk factors including lipoprotein (VLDL, LDL, HDL and HDL subfractions, HDL2/3) and apolipoprotein (apoA-I, A-II, B) levels, fasting and post-challenge glucose levels, a number of coagulation parameters including indicators of coagulation, fibrinolysis and platelet aggregation, and blood pressure, but also on potentially important changes in the composition of lipoproteins. We will additionally examine effects on the density distribution of LDL particles and on levels and composition of LDL in subgroups of the study population. The results of the proposed studies will provide information to allow an informed decision on defining which strategy provides optimal protection against bone loss and endometrial hyperplasia, but minimal alteration of the beneficial cardiovascular effects of estrogen.