Whayne Thomas F, Mukherjee Debabrata
aDivision of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky bDivision of Cardiovascular Medicine, Texas Tech University HSC, and Paul Foster School of Medicine, El Paso, Texas, USA.
Curr Opin Cardiol. 2015 Jul;30(4):432-8. doi: 10.1097/HCO.0000000000000157.
Cardiovascular disease considerations are associated with the menopause. Despite a misconception that women have a minimal risk for coronary heart disease (CHD), it is the major cause of female deaths. This review highlights issues of hormone replacement therapy (HRT) and CHD in women.
A woman under age 60, who suffers a myocardial infarction (MI), has a 2-year post-MI mortality of 28.9%; it is 19.6% in men. CHD and MI in women are subtle. In addition, female mortality from CHD increases after the menopause. The increased inflammatory risk factor status of women plays a role in development of atherosclerosis, before and after the menopause. Until after the menopause, women overall have a lower CHD mortality rate. Menopause is associated with unique symptoms, especially vasomotor ones; preexisting cardiovascular disease further exacerbates problems associated with the menopause. Use of HRT after the menopause is a major issue. Early menopause at age 39 years or younger and late menopause at age 56 years or older increase cardiovascular risk. HRT should not be prescribed for cardiovascular risk prevention, but when less than 10 years from menopause at a normal age, women can be reassured that cardiovascular risk from HRT is very low.
Prescription of HRT should never be made only for cardiovascular risk reduction. However, when symptom-related and other indications are present, HRT is appropriate and well tolerated in the early years after menopause with onset at a normal age.
心血管疾病的相关因素与绝经有关。尽管存在一种误解，认为女性患冠心病（CHD）的风险极小，但冠心病却是女性死亡的主要原因。本综述重点介绍了女性激素替代疗法（HRT）与冠心病的相关问题。
一名60岁以下的女性发生心肌梗死（MI）后，心肌梗死后2年的死亡率为28.9%；男性为19.6%。女性的冠心病和心肌梗死症状较为隐匿。此外，绝经后女性因冠心病导致的死亡率会增加。女性炎症风险因素状态的增加在绝经前后动脉粥样硬化的发展中起作用。在绝经前，女性总体上冠心病死亡率较低。绝经与独特的症状相关，尤其是血管舒缩症状；已有的心血管疾病会进一步加剧与绝经相关的问题。绝经后使用激素替代疗法是一个主要问题。39岁及以下的过早绝经和56岁及以上的过晚绝经会增加心血管风险。不应为预防心血管风险而开具激素替代疗法，但如果在正常绝经年龄后不到10年，女性可以放心，激素替代疗法带来的心血管风险非常低。
绝不能仅为降低心血管风险而开具激素替代疗法的处方。然而，当存在与症状相关的其他指征时，在正常年龄开始绝经后的早期，激素替代疗法是合适的，且耐受性良好。
