Ylikorkala Olavi
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, Haartmaninkatu 2, 00029 HUS, Helsinki, Finland.
Maturitas. 2004 Apr 15;47(4):315-8. doi: 10.1016/j.maturitas.2003.10.014.
To review the evidence of the efficacy of postmenopausal hormone replacement therapy (HRT) in secondary prevention of coronary artery disease or stroke.
Although a number of rather large and prolonged non-randomized observational studies have produced convincing and consistent evidence of the efficacy of HRT in the prevention of recurrence of cardiac events, the first randomized, placebo controlled trial (RCT) on heart disease and estrogen replacement study (HERS) reported no benefit of conjugated equine estrogen (CEE) and medroxyprogesterone acetate (MPA) in secondary prevention of cardiac events in women with established coronary artery disease. This was supported by RCT reporting no effect of CEE or CEE + MPA on the progress of coronary sclerosis. Similarly, some nonrandomized observational studies have evaluated the risk of recurrent stroke in regard to the use of HRT, and the data are conflicting reporting a reduced or increased risk of recurrence for HRT users. One RCT has shown that low-dose estrogen treatment can only slow down the progression of carotid arteriosclerosis in high-risk postmenopausal women, whereas two other RCTs have shown no benefit (or risk) of using HRT for secondary prevention of ischemic stroke or progression of carotid atherosclerosis.
The evidence accumulated so far shows that HRT has no place in secondary prevention of coronary or carotic artery disease. Its use in these patients must be based on solid nonvascular indications and expected benefits from these causes.
回顾绝经后激素替代疗法（HRT）在冠状动脉疾病或中风二级预防中疗效的证据。
尽管一些规模较大且持续时间较长的非随机观察性研究已产生令人信服且一致的证据，证明HRT在预防心脏事件复发方面的疗效，但第一项关于心脏病和雌激素替代研究（HERS）的随机、安慰剂对照试验报告称，结合马雌激素（CEE）和醋酸甲羟孕酮（MPA）对已确诊冠状动脉疾病的女性进行心脏事件二级预防并无益处。这一结果得到了另一项随机对照试验的支持，该试验报告称CEE或CEE + MPA对冠状动脉硬化进展无影响。同样，一些非随机观察性研究评估了使用HRT时复发性中风的风险，数据相互矛盾，报告称HRT使用者复发风险降低或增加。一项随机对照试验表明，低剂量雌激素治疗仅能减缓高危绝经后女性颈动脉粥样硬化的进展，而另外两项随机对照试验则表明，使用HRT对缺血性中风二级预防或颈动脉粥样硬化进展并无益处（或风险）。
迄今为止积累的证据表明，HRT在冠状动脉或颈动脉疾病的二级预防中并无作用。在这些患者中使用HRT必须基于可靠的非血管适应症以及这些病因所带来的预期益处。
