Mohandas Bhavna, Mehta Jawahar L
Division of Cardiovascular Medicine, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Curr Opin Cardiol. 2007 Sep;22(5):434-42. doi: 10.1097/HCO.0b013e328201cb7a.
Coronary heart disease in women is a common cause of morbidity and mortality, particularly after menopause. It was thought that estrogen and progesterone protected women from coronary heart disease. The recommendations of the recent Women's Health Initiative, however, are that hormone replacement therapy should not be used for primary prevention of coronary heart disease in women. Here, we have made a comprehensive review of major studies and comment on the validity of this recommendation. We have also analyzed the importance of dietary modification in primary prevention. In addition, we have delineated the important predictors of cardiovascular disease in women from prior observational and clinical studies.
Recent major studies, including the Women's Health Initiative (WHI) and Heart and Estrogen/Progestin Replacement Study (HERS), studied the role of hormone replacement therapy in protecting women from coronary heart disease. These studies showed no significant reduction in coronary heart disease events. In addition, the dietary modification component of the Women's Health Initiative did not show any significant reduction in the incidence of coronary heart disease.
It can be summarized that hormone replacement is not generally recommended in postmenopausal women for primary prevention of coronary heart disease. Although the dietary modification trials did not show any significant reduction in the incidence of coronary heart disease, it is currently recommended to continue using a heart-healthy diet.
女性冠心病是发病和死亡的常见原因，尤其是在绝经后。过去认为雌激素和孕激素可保护女性免受冠心病困扰。然而，近期妇女健康倡议（Women's Health Initiative）的建议是，激素替代疗法不应被用于女性冠心病的一级预防。在此，我们对主要研究进行了全面综述，并对该建议的有效性进行了评论。我们还分析了饮食调整在一级预防中的重要性。此外，我们从既往观察性和临床研究中梳理出了女性心血管疾病的重要预测因素。
近期的主要研究，包括妇女健康倡议（WHI）和心脏与雌激素/孕激素替代研究（HERS），探讨了激素替代疗法在保护女性免受冠心病困扰方面的作用。这些研究表明冠心病事件并未显著减少。此外，妇女健康倡议中的饮食调整部分也未显示冠心病发病率有任何显著降低。
可以总结出，一般不建议绝经后女性使用激素替代疗法进行冠心病的一级预防。尽管饮食调整试验未显示冠心病发病率有任何显著降低，但目前仍建议继续采用有益心脏健康的饮食。
