Knuuti Juhani, Kalliokoski Riikka, Janatuinen Tuula, Hannukainen Jarna, Kalliokoski Kari K, Koskenvuo Juha, Lundt Stefan
Turku PET Centre, University of Turku, Finland.
Am J Cardiol. 2007 Jun 15;99(12):1648-52. doi: 10.1016/j.amjcard.2007.01.042. Epub 2007 Apr 27.
Recent randomized clinical studies failed to show cardiovascular protection with postmenopausal hormone therapy (HT), instead raising widespread concerns about possible increased cardiovascular risk. However, these studies primarily assessed the combination of conjugated equine estrogen and medroxyprogesterone acetate, which is suspected to abolish the beneficial effects of estrogen on the microcirculation. This preliminary study evaluated the effects of HT combining 17beta-estradiol (E2) with a new progestin, drospirenone, on myocardial perfusion reserve, a surrogate marker of coronary function. In this double-blind randomized study, 56 postmenopausal women with angina pectoris received oral E2 1 mg plus drospirenone 2 mg or placebo for 6 weeks. Myocardial perfusion reserve was measured using radioactive oxygen-labeled water and positron emission tomography before and after therapy. Myocardial perfusion reserve increased significantly in the E2-drospirenone group after 6 weeks versus placebo (p<0.0008). Mean myocardial perfusion reserve increased from 4.83 at baseline to 5.13 after 6 weeks in the E2-drospirenone group (n=27), but decreased from 4.84 to 4.13 in the placebo group (n=29). No significant side effects were observed with E2-drospirenone. A larger trial is needed to investigate whether myocardial perfusion improvements will be sustained and translate into a clinical benefit in postmenopausal women at risk of coronary heart disease. In conclusion, E2-drospirenone HT for 6 weeks has favorable effects on myocardial function in postmenopausal women with angina pectoris. These data suggest that drospirenone has the desired progestin actions on the endometrium, but does not abolish the beneficial effects of estradiol on cardiac microcirculation.
近期的随机临床研究未能显示绝经后激素疗法（HT）具有心血管保护作用，反而引发了对心血管风险可能增加的广泛担忧。然而，这些研究主要评估的是结合马雌激素与醋酸甲羟孕酮的组合，人们怀疑这种组合会消除雌激素对微循环的有益作用。这项初步研究评估了17β-雌二醇（E2）与一种新型孕激素屈螺酮联合使用的激素疗法对心肌灌注储备（一种冠状动脉功能的替代指标）的影响。在这项双盲随机研究中，56名患有心绞痛的绝经后女性接受了为期6周的口服1毫克E2加2毫克屈螺酮或安慰剂治疗。在治疗前后，使用放射性氧标记水和正电子发射断层扫描测量心肌灌注储备。与安慰剂相比，E2-屈螺酮组在6周后心肌灌注储备显著增加（p<0.0008）。E2-屈螺酮组（n=27）的平均心肌灌注储备从基线时的4.83增加到6周后的5.13，但安慰剂组（n=29）从4.84降至4.13。E2-屈螺酮未观察到明显副作用。需要进行更大规模的试验来研究心肌灌注改善是否会持续，并转化为对有冠心病风险的绝经后女性的临床益处。总之，E2-屈螺酮激素疗法治疗6周对患有心绞痛的绝经后女性的心肌功能有有利影响。这些数据表明，屈螺酮对子宫内膜具有理想的孕激素作用，但不会消除雌二醇对心脏微循环的有益作用。
