Marek J
III. interní klinika 1. lékarské fakulty Karlovy Univerzity, Praha.
Vnitr Lek. 1992 Sep;38(9):913-20.
Epidemiological, experimental and clinical data verify that the risk of atherosclerotic cardiovascular disease is increased by a long-term estrogen deficiency. This is, among other beneficial effects of estrogens on arteries, caused by alteration of lipid and lipoprotein metabolism [e.g. decrease in total cholesterol, LDL-cholesterol and lipoprotein (a) and decrease in HDL2 cholesterol in serum and decrease in the accumulation of cholesterol in the arterial wall]. The beneficial cardioprotective effects of estrogens are attenuated by estrogen overdosing (causing hypertriglyceridemia), the use of synthetic instead of natural estrogen products (increased incidence of adversary effects) and especially by use of inappropriate progestins. The effect of progestins may be minimized by selecting a lower dose of a more metabolically inert products (especially progestins of the third generation). Mild to moderate hypercholesterolemia may improve with oral estrogen, and this strategy may be used as an adjunct for treatment. The replacement treatment of menopause is not yet widespread in Czechoslovakia. The new forms of treatment, not causing menstrual bleeding (continual medication, tamoxifen) may achieve more interest in the therapy. Hypogonadal men are known to have a more advanced development of atherosclerosis. The appropriate replacement is done by administration of such testosterone derivatives which enable the conversion to estrogens.
流行病学、实验和临床数据证实，长期雌激素缺乏会增加动脉粥样硬化性心血管疾病的风险。这是雌激素对动脉的诸多有益作用之一，是由脂质和脂蛋白代谢改变引起的[例如血清中总胆固醇、低密度脂蛋白胆固醇和脂蛋白(a)降低，高密度脂蛋白2胆固醇降低，动脉壁中胆固醇积累减少]。雌激素过量（导致高甘油三酯血症）、使用合成而非天然雌激素产品（不良反应发生率增加），尤其是使用不当的孕激素会削弱雌激素的有益心脏保护作用。通过选择较低剂量的代谢活性较低的产品（尤其是第三代孕激素），可以将孕激素的影响降至最低。轻度至中度高胆固醇血症可能会通过口服雌激素得到改善，这种策略可作为治疗的辅助手段。绝经替代治疗在捷克斯洛伐克尚未广泛应用。不引起月经出血的新治疗形式（持续用药、他莫昔芬）可能会在治疗中引起更多关注。已知性腺功能减退的男性动脉粥样硬化发展更为严重。通过给予能够转化为雌激素的睾酮衍生物进行适当替代。
