性激素,激素替代疗法与心血管疾病

绝经前女性的心血管疾病(CVD)风险及其发生率与同龄男性相比均较低,女性的这种性别优势却在绝经后逐渐消失,这表明,性激素,尤其是雌激素,在女性中具有心血管保护的作用。观察性研究显示女性绝经后接受激素替代疗法(HRT)可降低CVD的发病率。但是,随机前瞻性一级或二级预防试验未能证实HRT对心脏有积极影响。女性健康计划(WHI)与心脏及雌/孕激素替代研究(HERSⅠ和Ⅱ)表明,HRT使绝经后女性的CVD风险及患病率增高。HRT有利有弊的这种矛盾特性的原因尚不明确。该文重点讨论了造成这种相悖结果的可能原因,并尽可能揭示为何年青或绝经前女性CVD发病率偏低,绝经后女性并不受益于HRT。此外,在判断HRT效果时,应考虑到剂量、疗程、雌激素的类型及给药途径等因素。总之,基于年青或绝经前女性CVD发病率低,而HRT对绝经后女性并无心血管保护作用的事实,HRT已成为在女性健康方面最具有争议性的课题之一。因此,还需要进一步的研究以阐明为何HRT结果会不一致,并为提高女性生活质量提供新的治疗策略。

Sexual hormones , hormonal replacement therapy and cardiovascular disease

Premenopausal women have a lower risk and incidence of cardiovascular disease ( CVD ) compared to age- matched men and this gender advantage for women gradually disappears after menopause , suggesting that sexual hor- mones , most likely estrogen , play a cardioprotective role in women. Observational studies have shown that postm- enopausal on hormone replacement therapy ( HRT ) have a lower rate of CVD. However , randomized prospective primary or secondary prevention trials failed to confirm the beneficial cardiac effects of HRT. Both the Women’s Health Initiative ( WHI ) and the Heart and Estrogen / Progestin Replacement Study ( HERSⅠ andⅡ ) shown that HRT increase the risk and events of CVD in postmenopausal women. The reasons for this paradoxical characteriza- tion of HRT as both beneficial and detrimental remain unclear. This review highlights the factors that may contrib- ute to this divergent outcome and could reveal why young or premenopausal women are protected from CVD and yet postmenopausal women do not benefit from HRT. Moreover , dosage , duration , the type of estrogen and route of administration all merit consideration when determining the outcome of HRT. In summary , the fact that young or premenopausal women are protected from cardiovascular disease and yet postmenopausal women do not benefit from HRT has made HRT one of the most controversial topics related to women’s health. Future studies are necessary if we are to understand the divergent published findings regarding HRT and develop new therapeutic strategies to im- prove the quality of life for women.