MECHANISMS OF HORMONE THERAPY IN POSTMENOPAUSAL WOMEN

非对抗性雌激素或雌激素/孕激素联合疗法在乳腺癌中的应用 冠心病事件的一级和二级预防 更年期妇女在美国越来越受欢迎。支持这一 这种做法主要是基于流行病学协会的减少， 死亡和非致命性心肌梗死的风险 服用雌激素的女性中，大多数没有冠心病病史， 原因有很多在雌激素中加入一种雌激素的效果 研究得较少。因为潜在的公共卫生影响， 用激素替代疗法治疗绝经后妇女， 预防冠状动脉疾病事件是巨大的，这是 必须建立一个知识基金， 临床试验数据的解释，以帮助建立小组 或者说，他们是谁。 启动。为了实现这些目标，我们建议： 1.使用血管反应性的非侵入性测量， 添加抗氧化剂对血管内皮功能的影响 孕激素与雌激素治疗绝经后妇女 没有冠状动脉疾病 2. 研究绝经后不同组合的效果 激素治疗对凝血系统的影响 3.利用积累的临床试验数据库研究临床 可能影响激素替代疗法疗效的因素 用于绝经后冠心病的二级预防 妇女 拟议工作将提供对该机制的进一步了解 雌激素对内皮功能的作用（假设是 雌激素有益作用的主要机制）和 雌激素替代疗法中加入孕激素的效果。

The use of unopposed estrogen of combined estrogen/progestin therapy for primary and secondary prevention of coronary disease events in post- menopausal women is gaining favor in the United States. Support for this practice is based largely on epidemiological association of a reduction in the risk of death and non-fatal myocardial infarction in populations of women mostly without prior coronary artery disease who took estrogen for a variety of reasons. The effects of adding a progestin to estrogen are less well studied. Because the potential public health impact from treatment of post-menopausal women with hormone replacement therapy for prevention of coronary artery disease events is enormous, it is imperative to establish a fund of knowledge that supports and aids in the interpretation of clinical trials data to help establish the group or groups for whom treatment should be recommended and when it should be initiated. To accomplish these goals we propose: 1. Using non-invasive measurement of vascular reactivity, to quantify the effect on vascular endothelial function of the addition of progesterone to estrogen therapy in post-menopausal women with and without coronary artery disease. 2. To study the effect of various combinations of post-menopausal hormone therapy on the coagulation system. 3. To use accumulated clinical trials databases to study clinical factors that may influence the efficacy of hormone replacement therapy for secondary prevention of coronary artery disease in post-menopausal women. The propose work will provide additional understanding of the mechanism of estrogen action on endothelial function (which is postulated to be the major mechanism of the beneficial effects of estrogen) and the effects of adding progestins to estrogen replacement regimens.