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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。
The risk of cardiovascular disease (CVD) and the prevalence of premenopausal women are low compared to men of the same age, but this gender predominance in women is diminishing after menopause, indicating that sex hormones, estrogen in particular, are found in women With cardiovascular protection. Observational studies have shown that women receiving hormone replacement therapy (HRT) after menopause reduce the incidence of CVD. However, randomized prospective primary or secondary prevention trials have failed to confirm that HRT has a positive effect on the heart. Women’s Health Program (WHI) and Cardiac and Estrogen / Progestin Replacement Studies (HERS I and II) have shown that HRT increases the risk of CVD and the prevalence of postmenopausal women. The reasons for this contradictory nature of HRT’s pros and cons are not yet clear. This article focuses on the possible causes of this inconsistent outcome and, to the extent possible, sheds light on the low prevalence of CVD among young or pre-menopausal women who do not benefit from HRT. In addition, in judging the HRT effect, should take into account the dose, treatment, estrogen type and route of administration and other factors. In conclusion, HRT has become one of the most controversial issues in women’s health, based on the fact that young women or premenopausal women have a low prevalence of CVD and HRT has no cardiovascular protective effect on postmenopausal women. Therefore, further research is needed to clarify why HRT results will be inconsistent and to provide new treatment strategies for improving the quality of life for women.