Kuhl H
Zentrum der Frauenheikunde, J.W. Goethe-Universität Frankfurt am Main.
Geburtshilfe Frauenheilkd. 1988 Nov;48(11):747-56. doi: 10.1055/s-2008-1026621.
Epidemiological, experimental and clinical data verify that the risk of cardiovascular diseases is increased by a long-term estrogen deficiency. This is, among other things, caused by alterations of lipid metabolism (e.g., rise in total cholesterol and LDL-cholesterol, decrease in HDL-cholesterol) due to the estrogen dificit which are involved in an accelerated development of atherosclerosis. If there is an estrogen deficiency, an elevated serum level of cholesterol or LDL-cholesterol can be reduced and the HDL-cholesterol level can be increased by an adequate estrogen replacement therapy, i.e., treatment with an estrogen and progestogen the type and dose of which are adjusted to the clinical picture. When the present knowledge about the physiological and pathological pathways is weighed and the epidemiological data are critically valued - whereby the extent and duration of the stage of estrogen deficit has to be regarded as an important criterion -, it can be assumed that an estrogen therapy prevents a premature atherosclerosis and coronary heart disease provided that they are related to an estrogen deficiency. The differences in the degree of estrogen deficit and the symptoms as well as in the pharmacological and pharmacodynamic peculiarities if the individual women render it necessary to adjust individually the estrogen therapy, to avoid overdosing and to pay attention to risk factors. Therefore, an undifferentiated treatment with estrogens (e.g. estrogen for every woman) does not appear to be appropriate.
流行病学、实验和临床数据证实，长期雌激素缺乏会增加心血管疾病的风险。除其他因素外，这是由于雌激素缺乏导致脂质代谢改变（例如，总胆固醇和低密度脂蛋白胆固醇升高，高密度脂蛋白胆固醇降低），这些改变参与了动脉粥样硬化的加速发展。如果存在雌激素缺乏，通过适当的雌激素替代疗法，即使用雌激素和孕激素进行治疗，且其类型和剂量根据临床情况进行调整，可以降低血清胆固醇或低密度脂蛋白胆固醇水平，并提高高密度脂蛋白胆固醇水平。当权衡当前关于生理和病理途径的知识并严格评估流行病学数据时——其中雌激素缺乏阶段的程度和持续时间必须被视为一个重要标准——可以假设，雌激素疗法可以预防与雌激素缺乏相关的过早动脉粥样硬化和冠心病。个体女性在雌激素缺乏程度、症状以及药理和药效学特性方面存在差异，这使得有必要个体化调整雌激素疗法，以避免用药过量并关注风险因素。因此，不加区分地使用雌激素进行治疗（例如，给每个女性都使用雌激素）似乎并不合适。
