Department of Obstetrics and Gynecology, Columbia University, New York, NY 10032, USA.
Menopause. 2011 Feb;18(2):237-40.
In younger postmenopausal women, estrogen is thought to be protective against coronary heart disease. The mechanism for this effect is likely to be an inhibition of the development of atherosclerosis. However, in older postmenopausal women with established atherosclerosis, the initiation of estrogen therapy may cause coronary artery plaque instability and rupture, resulting in coronary thrombosis and myocardial infarction. Compared with these findings of coronary disease prevention in younger women, estrogen therapy has been linked to an increased risk of ischemic stroke in both younger and older postmenopausal women, although the risk is small and the event rate in younger women is considered to be rare. Here, we provide an argument that the mechanism for stroke risk in younger women is not based on atherosclerotic disease, as occurs in older women for both coronary disease and stroke, but is related to thrombosis. Susceptibility for stroke is increased in women, and various factors leading to thrombosis may explain this risk. This notion is supported by data that estrogen regimens that decrease the risk of venous thrombosis (lower oral doses and transdermal therapy) may not be associated with an increase in ischemic stroke risk.
在较年轻的绝经后女性中，雌激素被认为可以预防冠心病。这种作用的机制可能是抑制动脉粥样硬化的发展。然而，对于已经患有动脉粥样硬化的老年绝经后女性，开始雌激素治疗可能会导致冠状动脉斑块不稳定和破裂，从而导致冠状动脉血栓形成和心肌梗死。与这些年轻女性预防冠心病的发现相比，雌激素治疗与年轻和老年绝经后女性的缺血性卒中风险增加相关，尽管风险较小，且年轻女性的事件发生率被认为罕见。在这里，我们提出一个论点，即年轻女性中风风险的机制不是基于动脉粥样硬化疾病，如老年女性的冠心病和中风，而是与血栓形成有关。女性中风的易感性增加，导致血栓形成的各种因素可能解释这种风险。这一观点得到了数据的支持，即降低静脉血栓形成风险的雌激素方案（较低的口服剂量和经皮治疗）可能与缺血性卒中风险增加无关。
