Obstet Gynecol. 2013 Jun;121(6):1407-1410. doi: 10.1097/01.AOG.0000431053.33593.2d.
Menopausal hormone therapy should not be used for the primary or secondary prevention of coronary heart disease at the present time. Evidence is insufficient to conclude that long-term estrogen therapy or hormone therapy use improves cardiovascular outcomes. Nevertheless, recent evidence suggests that women in early menopause who are in good cardiovascular health are at low risk of adverse cardiovascular outcomes and should be considered candidates for the use of estrogen therapy or conjugated equine estrogen plus a progestin for relief of menopausal symptoms. There is some evidence that lends support to the "timing hypothesis," which posits that cardiovascular benefit may be derived when estrogen therapy or hormone therapy is used close to the onset of menopause, but the relationship of duration of therapy to cardiovascular outcomes awaits further study. Clinicians should encourage heart-healthy lifestyles and other strategies to reduce cardiovascular risk in menopausal women. Because some women aged 65 years and older may continue to need systemic hormone therapy for the management of vasomotor symptoms, the American College of Obstetricians and Gynecologists recommends against routine discontinuation of systemic estrogen at age 65 years. As with younger women, use of hormone therapy and estrogen therapy should be individualized based on each woman's risk-benefit ratio and clinical presentation.
绝经激素治疗目前不应用于冠心病的一级或二级预防。证据不足，不能得出长期雌激素治疗或激素治疗可改善心血管结局的结论。然而，最近的证据表明，心血管健康良好的早期绝经女性发生不良心血管结局的风险较低，应考虑使用雌激素治疗或结合马雌激素加孕激素来缓解绝经症状。有一些证据支持“时机假说”，该假说认为，当接近绝经时使用雌激素治疗或激素治疗可能会带来心血管益处，但治疗持续时间与心血管结局的关系仍有待进一步研究。临床医生应鼓励绝经女性保持心脏健康的生活方式和其他降低心血管风险的策略。由于一些 65 岁及以上的女性可能仍需要全身性激素治疗来管理血管舒缩症状，美国妇产科医师学会不建议常规在 65 岁时停止全身性雌激素治疗。与年轻女性一样，激素治疗和雌激素治疗的使用应根据每位女性的风险效益比和临床表现个体化。
