Emory University School of Medicine, Emory Women's Heart Center, Atlanta, GA, USA.
Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Primary, Community and Social Care, Keele University, Stoke-on-Trent, Staffordshire, UK.
Curr Atheroscler Rep. 2020 Jun 18;22(8):33. doi: 10.1007/s11883-020-00854-8.
For decades the medical community recommended menopausal hormone therapy (MHT) for prevention of atherosclerotic cardiovascular disease (ASCVD) and osteoporosis in addition to relieving unpleasant vasomotor and genitourinary symptoms. These recommendations were largely based on observational studies. Several large randomized placebo-controlled trials led to the surprising finding that postmenopausal women were at higher risk of cardiovascular disease (CVD) events compared with women in the placebo group. For the next decade, women were less frequently prescribed MHT and more often declined MHT.
Today, there are more evidence-based guidelines utilizing sex-specific ASCVD risk factors to assess risk in women. More recent studies have shed new light on safety and potential benefits for women initiating MHT earlier with newer options for route of administration, dosing, and combinations. Recent studies suggest MHT safety in younger women, women within 10 years of menopause, and women who use low-dose MHT for short durations for menopause symptom relief. Transdermal, newer low-dose oral therapies and SERM therapies may also have lower risk and be reasonable considerations for women. Healthcare providers need to be aware of the current options for MHT, current indications, contraindications, long-term ASCVD risks, and nonhormonal options for high-risk women.
几十年来，医学界建议绝经后激素治疗（MHT）用于预防动脉粥样硬化性心血管疾病（ASCVD）和骨质疏松症，此外还可缓解令人不适的血管舒缩和泌尿生殖系统症状。这些建议主要基于观察性研究。几项大型随机安慰剂对照试验得出了令人惊讶的发现，与安慰剂组的女性相比，绝经后女性发生心血管疾病（CVD）事件的风险更高。在接下来的十年中，女性开 MHT 的频率降低，而拒绝 MHT 的频率增加。
如今，有更多基于循证的指南利用特定性别的 ASCVD 风险因素来评估女性的风险。最近的研究为早期开始 MHT 的女性提供了新的安全性和潜在益处，包括新的给药途径、剂量和组合。最近的研究表明，对于年轻女性、绝经 10 年内的女性以及使用低剂量 MHT 缓解绝经症状的女性，MHT 是安全的。经皮、新型低剂量口服治疗和 SERM 治疗的风险也可能较低，对于女性来说也是合理的考虑。医疗保健提供者需要了解 MHT 的当前选择、当前适应症、禁忌症、长期 ASCVD 风险以及高危女性的非激素选择。
