Division of Clinical Physiology and Nuclear Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Menopause. 2012 Jan;19(1):82-8. doi: 10.1097/gme.0b013e318221bae8.
The aim of the study was to compare the responses of heart rate variability (HRV) with hormone therapy in recently postmenopausal women with and without vasomotor hot flashes.
Seventy-two women with and 78 women without hot flashes were randomized to receive transdermal estradiol gel (1 g/day), oral estradiol alone (2 mg/day), oral estradiol combined with medroxyprogesterone acetate (MPA; 5 mg/day), or placebo for 6 months. Time- and frequency-domain measures of HRV were assessed using 24-hour electrocardiographic recordings at baseline and after hormone therapy.
At baseline, the cardiac variables were similar in women with and without hot flashes. In women with hot flashes, the mean 24-hour heart rate and nighttime heart rate showed a tendency toward reduction in estradiol-only users compared with those taking placebo and those taking estradiol combined with MPA. In women with hot flashes, oral estradiol versus transdermal estradiol reduced nighttime HRV in the time domain (triangular index, -27 ± 36 vs +8 ± 36, P = 0.042). In women without hot flashes, the use of oral estradiol with MPA reduced time-domain HRV (SD of all normal-to-normal intervals; -11 ± 13 ms, P = 0.048, and square root of the mean of the sum of the squares of differences between adjacent normal-to-normal intervals; -6 ± 8 ms, P = 0.036). The women with hot flashes had more supraventricular ectopic beats when using oral estradiol with MPA than when using oral estradiol only (71 ± 128 vs 12 ± 11, P = 0.018).
Oral estrogen, especially when combined with MPA, may have adverse effects on HRV in women with and without hot flashes, whereas transdermal estradiol showed no such effects. Furthermore, women with hot flashes receiving oral estrogen combined with MPA are possibly more prone to cardiac arrhythmias than are women using estrogen only.
本研究旨在比较激素治疗对近期绝经后伴或不伴血管舒缩性热潮红女性心率变异性（HRV）的影响。
72 例有热潮红的女性和 78 例无热潮红的女性被随机分为三组，分别接受经皮雌二醇凝胶（1 g/天）、单独口服雌二醇（2 mg/天）、口服雌二醇联合醋酸甲羟孕酮（MPA；5 mg/天）或安慰剂治疗 6 个月。在基线和激素治疗后，使用 24 小时心电图记录评估 HRV 的时频域指标。
基线时，有热潮红和无热潮红的女性心脏变量相似。在有热潮红的女性中，与安慰剂组和雌二醇联合 MPA 组相比，单独使用雌二醇的女性 24 小时平均心率和夜间心率有降低的趋势。在有热潮红的女性中，与经皮雌二醇相比，口服雌二醇降低了夜间 HRV 的时域指标（三角指数，-27 ± 36 对 +8 ± 36，P = 0.042）。在无热潮红的女性中，口服雌二醇联合 MPA 降低了时域 HRV（所有正常-正常间期的标准差；-11 ± 13 ms，P = 0.048，和相邻正常-正常间期均方和的平方根；-6 ± 8 ms，P = 0.036）。与单独使用口服雌二醇相比，口服雌二醇联合 MPA 组的女性有更多的室上性期前收缩（71 ± 128 对 12 ± 11，P = 0.018）。
口服雌激素，尤其是与 MPA 联合使用，可能对有或无热潮红的女性的 HRV 产生不良影响，而经皮雌二醇则没有这种影响。此外，与单独使用雌激素相比，服用雌二醇联合 MPA 的有热潮红的女性可能更容易发生心律失常。
