Lawlor Debbie A, Smith George Davey
Department of Social Medicine, University of Bristol, Bristol, UK.
Curr Opin Obstet Gynecol. 2006 Dec;18(6):658-65. doi: 10.1097/GCO.0b013e32800ff5af.
The purpose of this review is to summarize the studies in humans of the relationship between hormone replacement therapy and coronary heart disease and stroke.
Randomized controlled trial evidence of the effect of hormone replacement therapy on coronary heart disease, stroke and atherosclerosis comes from nine individual secondary prevention randomized controlled trials, four individual primary prevention randomized controlled trials and a pooled analysis of 22 randomized controlled trials that had primary aims to examine noncardiovascular outcomes but which reported cardiovascular events by randomized groups. With the exception of one small primary prevention randomized controlled trial that found a weak protective effect of hormone replacement therapy on the progression of carotid artery intima media thickness, all other randomized controlled trials have found hormone replacement therapy either increases the risk of cardiovascular disease or has no effect.
Randomized controlled trial evidence conducted in a variety of populations suggests that hormone replacement therapy is not protective against the risk of coronary heart disease, stroke or progression of atherosclerosis. The prevention of cardiovascular disease in women, as in men, should focus on implementing effective methods of reducing smoking, obesity, high blood pressure, dyslipidaemia and glucose intolerance.
本综述旨在总结人类中激素替代疗法与冠心病和中风之间关系的研究。
激素替代疗法对冠心病、中风和动脉粥样硬化影响的随机对照试验证据来自九项个体二级预防随机对照试验、四项个体一级预防随机对照试验以及对22项随机对照试验的汇总分析，这些试验的主要目的是检查非心血管结局，但按随机分组报告了心血管事件。除了一项小型一级预防随机对照试验发现激素替代疗法对颈动脉内膜中层厚度进展有微弱保护作用外，所有其他随机对照试验均发现激素替代疗法要么增加心血管疾病风险，要么没有效果。
在各种人群中进行的随机对照试验证据表明，激素替代疗法不能预防冠心病、中风或动脉粥样硬化进展的风险。与男性一样，女性心血管疾病的预防应侧重于实施减少吸烟、肥胖、高血压、血脂异常和糖耐量异常的有效方法。
