Wren B G
Centre for the Management of the Menopause, Royal Hospital for Women, Paddington, NSW.
Med J Aust. 1992 Aug 3;157(3):204-8. doi: 10.5694/j.1326-5377.1992.tb137091.x.
To review the present state of knowledge regarding the effect of oestrogen on the female cardiovascular system (e.g. atherosclerosis, myocardial infarction, hypertension and thrombosis).
Over 100 articles (most published over the last 10 years) were reviewed. They included epidemiological, biochemical, physiological, animal and clinical studies which related to the effect oestrogens have on the cardiovascular system of postmenopausal women. These data contained a wide cross-section of results and outcomes and each study was summarised to provide the most relevant information. Where a particular study provided an opinion or result at variance with the majority opinion, that study has been discussed in greater detail.
All published papers which appeared to be relevant to an understanding of the clinical implications of oestrogen replacement therapy and its impact on the female cardiovascular system were included in this analysis. Some papers which appeared to repeat data and results previously published were not included.
The overwhelming eight of evidence from this literature review supports the concept that oestrogen reduces the risk of atherosclerosis and myocardial infarction. It also confirms that postmenopausal "natural" oestrogen is a vasodilating agent which will lead to a fall in blood pressure and an improvement in blood flow and the pulsatility index. Although oral oestrogen did appear to increase thrombogenic activity, there was no clinical evidence that "natural" oestrogen taken after the menopause increased the risk of venous thrombosis.
The consensus of the published data is that oestrogen conveys a highly protective effect on the cardiovascular system of postmenopausal women. There will be a reduction of up to 50% in myocardial infarction and stroke, a reduction in the incidence of hypertension and an improvement in blood flow. Some of the data suggest that even for women who have suffered from an infarct, their long-term survival is enhanced by oestrogen therapy. The medical myth that oestrogen has a deleterious effect on the cardiovascular system of women is finally laid to rest.
综述关于雌激素对女性心血管系统（如动脉粥样硬化、心肌梗死、高血压和血栓形成）影响的现有知识状况。
查阅了100多篇文章（大多数发表于过去10年）。这些文章包括流行病学、生物化学、生理学、动物和临床研究，涉及雌激素对绝经后女性心血管系统的影响。这些数据包含广泛的结果和结局，对每项研究进行了总结以提供最相关的信息。若某项特定研究给出的观点或结果与多数观点不同，则对该研究进行了更详细的讨论。
所有似乎与理解雌激素替代疗法的临床意义及其对女性心血管系统的影响相关的已发表论文均纳入本分析。一些似乎重复先前发表的数据和结果的论文未被纳入。
本次文献综述中压倒性的证据支持雌激素降低动脉粥样硬化和心肌梗死风险这一概念。还证实绝经后“天然”雌激素是一种血管舒张剂，会导致血压下降、血流和搏动指数改善。虽然口服雌激素似乎确实增加了血栓形成活性，但没有临床证据表明绝经后服用“天然”雌激素会增加静脉血栓形成的风险。
已发表数据的共识是，雌激素对绝经后女性的心血管系统具有高度保护作用。心肌梗死和中风将减少多达50%，高血压发病率降低，血流改善。一些数据表明，即使对于曾患心肌梗死的女性，雌激素治疗也能提高其长期生存率。雌激素对女性心血管系统有有害影响这一医学误区终于被消除。
