Taylor Jennifer E, Baig Mariam S, Helmy Tarek, Gersh Felice L
From the Division of Cardiology, St. Louis University Hospital, St. Louis, MO.
Department of Medicine, St. Louis University Hospital, St. Louis, MO.
Cardiol Rev. 2021;29(6):296-304. doi: 10.1097/CRD.0000000000000353.
The debate over the safety and benefit of hormone replacement therapy (HRT) in postmenopausal women for primary prevention of cardiovascular disease (CVD) has been ongoing for the past several decades. Observational trials in the 1980s suggested a benefit of HRT for primary CVD prevention. However, randomized controlled trials in the 1990s suggested potential harm. Because of these discrepancies, recommendations from authorities on the usage of postmenopausal HRT have fluctuated. Many believed that the timing of HRT initiation relative to the onset of menopause, also known as the "timing hypothesis," was the factor that could explain the differences among these studies. Some recent investigations have concluded that HRT initiated in postmenopausal women near the onset of menopause confers a cardioprotective benefit, while others simply showed that HRT does not cause harm. Research has expanded to evaluate alternative doses, preparations, routes, and formulations, including selective estrogen receptor modulators, to demonstrate their suitability for this purpose. This article is a review of the major research studies of HRT in postmenopausal women with respect to its safety and efficacy for the primary prevention of CVD.
关于激素替代疗法（HRT）在绝经后女性中用于心血管疾病（CVD）一级预防的安全性和益处的争论在过去几十年中一直持续。20世纪80年代的观察性试验表明HRT对CVD一级预防有益。然而，20世纪90年代的随机对照试验表明存在潜在危害。由于这些差异，有关绝经后HRT使用的权威建议一直在波动。许多人认为，HRT开始的时间相对于绝经的开始，即所谓的“时间假说”，是可以解释这些研究之间差异的因素。最近的一些调查得出结论，在绝经后女性接近绝经开始时开始使用HRT具有心脏保护作用，而其他一些调查只是表明HRT不会造成伤害。研究已经扩展到评估替代剂量、制剂、途径和配方，包括选择性雌激素受体调节剂，以证明它们适用于此目的。本文是对绝经后女性HRT在CVD一级预防方面的安全性和有效性的主要研究的综述。
