Bittner Vera
University of Alabama at Birmingham, Division of Cardiovascular Disease, 701 19th Street South - LHRB 310, Birmingham, Alabama 35294-0007, USA.
Expert Opin Pharmacother. 2009 Sep;10(13):2041-53. doi: 10.1517/14656560903066829.
Risks and benefits of postmenopausal hormone therapy remain highly controversial. After publication of the Women's Health Initiative hormone trials and several other major trials, the American Heart Association designated postmenopausal hormone therapy as 'Class III', if initiated for the purpose of cardiovascular disease prevention. Subsequent post hoc analyses of the Women's Health Initiative data have renewed enthusiasm for hormone therapy among younger postmenopausal women.
To review data from randomized clinical trials that have assessed cardiovascular outcomes of hormone therapy including coronary heart disease, stroke, peripheral arterial disease, and venous thromboembolism.
The review focuses on cardiovascular effects of hormone therapy only and does not attempt to integrate potential risks and benefits related to symptoms, cancer, osteoporosis or other noncardiovascular effects of postmenopausal hormone therapy. The literature search included original trial publications, post hoc analyses, and aggregate data from meta-analyses published in English and accessible to the author in full-text format for detailed analysis.
RESULTS/CONCLUSION: Risks of hormone therapy seem to predominate among older postmenopausal women. Data among younger women close to menopause are insufficient to recommend such therapy for cardiovascular disease prevention.
绝经后激素治疗的风险和益处仍然极具争议。在妇女健康倡议激素试验及其他几项主要试验发表后，美国心脏协会将绝经后激素治疗指定为“Ⅲ类”（若出于预防心血管疾病的目的而启动）。随后对妇女健康倡议数据进行的事后分析，重新燃起了年轻绝经后女性对激素治疗的热情。
回顾评估激素治疗心血管结局（包括冠心病、中风、外周动脉疾病和静脉血栓栓塞）的随机临床试验数据。
该综述仅关注激素治疗的心血管效应，并未尝试综合绝经后激素治疗与症状、癌症、骨质疏松症或其他非心血管效应相关的潜在风险和益处。文献检索包括原始试验出版物、事后分析以及以英文发表且作者可获取全文格式以供详细分析的荟萃分析汇总数据。
结果/结论：激素治疗的风险在老年绝经后女性中似乎占主导。接近绝经的年轻女性的数据不足以推荐将此类治疗用于预防心血管疾病。
