Maas A H E M, van der Graaf Y
Isala klinieken, afd. Cardiologie, Postbus 10.400, 8000 GK Zwolle.
Ned Tijdschr Geneeskd. 2002 Nov 9;146(45):2127-30.
Results from the Women's Health Initiative randomized trial in 16,608 healthy postmenopausal women have revealed more risks than benefits in terms of invasive breast cancer and cardiovascular disease rates in patients treated for more than 5 years with a combination of conjugated oestrogens and progestin compared with placebo. Hormone-replacement therapy (HRT) is more effective in healthy women (maintaining vascular health) than in older women with atherosclerosis (restoring endothelial dysfunction). The initiation of HRT in patients at risk of a cardiovascular event results in an increased rate of cardiovascular complications and has not been proven beneficial in the long term. The point at which HRT is started after menopause plays a crucial role in the effectiveness of hormones on the vascular system: it is uncertain whether HRT initiated shortly after menopause can delay clinical signs of atherosclerotic disease.
妇女健康倡议对16608名健康绝经后妇女进行的随机试验结果显示，与安慰剂相比，接受联合使用共轭雌激素和孕激素治疗5年以上的患者，在浸润性乳腺癌和心血管疾病发病率方面，风险大于益处。激素替代疗法（HRT）对健康女性（维持血管健康）比对患有动脉粥样硬化的老年女性（恢复内皮功能障碍）更有效。有心血管事件风险的患者开始使用HRT会导致心血管并发症发生率增加，且长期来看并未证明有益。绝经后开始使用HRT的时间点对激素对血管系统的有效性起着关键作用：绝经后不久开始使用HRT是否能延缓动脉粥样硬化疾病的临床症状尚不确定。
