Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
Curr Opin Obstet Gynecol. 2011 Aug;23(4):258-67. doi: 10.1097/GCO.0b013e3283488a21.
Coronary heart disease (CHD) is the leading cause of death in the aging female population in the developed world. Ovarian endocrinology plays an important role in modulating a woman's CHD risk. We herein present an overview of our current understanding of CHD risk profile in the context of ovarian physiology and senescence.
Endogenous ovarian estrogen has long been recognized to offer cardiac benefit and vascular protection against atherosclerosis. Existing data, however, do not allow for an extrapolation of the recognized cardioprotective implications of the reproductive-age endogenous estrogenic milieu to the use of exogenous estrogen in postmenopausal women. Ongoing efforts are targeting the concept that when reintroduced proximate to onset of ovarian senescence, exogenous estrogen may retard the process of atherogenesis. Until this hypothesis is substantiated, cardioprotection must not be an indication for initiating hormone therapy in menopausal women.
Ovarian hormones modulate the processes of atherosclerosis and the mechanisms underlying CHD. The female reproductive hormones offer a cardioprotective milieu that is rapidly attenuated with the cessation of ovarian function (be it following natural menopause or after medical or surgical ovarian extirpation). The role of exogenous hormone therapy, and the nuances of timing and duration of exposure, are still being elucidated.
在发达国家，冠心病（CHD）是老年女性人群的主要致死原因。卵巢内分泌在调节女性 CHD 风险方面发挥着重要作用。本文概述了我们目前对卵巢生理学和衰老背景下 CHD 风险特征的理解。
内源性卵巢雌激素长期以来被认为对心脏有益，并能防止动脉粥样硬化引起的血管损伤。然而，现有数据不允许将生育期内源性雌激素环境所公认的心脏保护意义外推到绝经后妇女使用外源性雌激素。目前正在努力研究一个概念，即当外源性雌激素接近卵巢衰老开始时重新引入，可能会延缓动脉粥样硬化的发生过程。在这一假设得到证实之前，绝经期妇女不应将心脏保护作为开始激素治疗的指征。
卵巢激素调节动脉粥样硬化和 CHD 的发生机制。女性生殖激素提供了一种心脏保护环境，随着卵巢功能的停止（无论是自然绝经后还是医学或手术卵巢切除后），这种环境会迅速减弱。外源性激素治疗的作用，以及暴露时间和持续时间的细微差别，仍在阐明之中。
