POSTMENOPAUSAL HORMONE THERAPY--RISKS AND BENEFITS

冠状动脉疾病（CAD）和骨质疏松症是两个主要疾病 绝经后妇女的医疗问题。 同时 建议进行雌激素/孕激素替代治疗 预防骨质流失，雌激素和孕激素有 对许多 CAD 风险具有重要且常常相反的影响 因素。 我们提出全面综合的三年评估 九种不同治疗策略对骨量的影响 保留、子宫内膜状态、胆结石形成等 与一组可比较的 CAD 风险因素相比 控制。 实验组将仅包含三种雌激素 组（仅限子宫切除女性），以及六组 雌激素/孕激素组以评估剂量、模式的影响 给药方式、孕激素类型和激素时间 对这些参数进行管理。 该研究不仅将确定对 CAD 危险因素的影响 包括脂蛋白（VLDL、LDL、HDL 和 HDL 亚组分， HDL2/3) 和载脂蛋白 (apoA-I、A-II、B) 水平，空腹和 攻击后血糖水平、许多凝血参数 包括凝血、纤溶和血小板指标 聚集和血压，而且还具有潜在的重要作用 脂蛋白的组成发生变化。 我们还将另外 检查对 LDL 颗粒密度分布的影响 研究亚组中 LDL 水平和组成 人口。 拟议研究的结果将提供 信息，以便就定义哪些内容做出明智的决定 策略提供了针对骨质流失的最佳保护， 子宫内膜增生，但有益的改变很小 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.