Shufelt Chrisandra L, Manson JoAnn E
Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Clin Endocrinol Metab. 2021 Apr 23;106(5):1245-1254. doi: 10.1210/clinem/dgab042.
This mini-review provides an overview of menopausal hormone therapy (HT) and cardiovascular disease (CVD) risk, with a focus on the role of hormone formulation, dose, and route of delivery.
This summary is based on authors' knowledge in the field of menopausal HT and supplemented by a PubMed search using the terms "menopause hormone therapy," "transdermal," "estradiol," "conjugated estrogens," "bioidentical," "cardiovascular disease," "lipoproteins," "glucose," "progestogens," "low dose."
Available evidence indicates that oral unopposed estrogens have a favorable effect on lipoprotein levels, glycemia, insulin, and CVD risk; however, the addition of progestogens blunts the lipid-related effects. The progestogen with the smallest attenuating effect is micronized progesterone. Transdermal estrogens have less effect on coagulation, inflammation, and lipids than oral estrogens and observational studies suggest they pose a lower risk of venous thromboembolism and stroke than oral estrogens. Clinical effects of hormones were not consistently dose dependent.
Although HT continues to have an important role in menopause management, it is not recommended for primary or secondary CVD prevention. Different formulations, doses, and routes of delivery of HT have different effects on cardiometabolic markers and risks of clinical CVD events. However, long-term trials evaluating clinical outcomes with transdermal and other alternate HT regimens are limited.
本综述概述了绝经激素治疗（HT）与心血管疾病（CVD）风险，重点关注激素制剂、剂量和给药途径的作用。
本综述基于作者在绝经激素治疗领域的知识，并通过使用“绝经激素治疗”“经皮”“雌二醇”“结合雌激素”“生物同源物”“心血管疾病”“脂蛋白”“葡萄糖”“孕激素”“低剂量”等术语在PubMed上进行检索作为补充。
现有证据表明，口服单一雌激素对脂蛋白水平、血糖、胰岛素和心血管疾病风险有有益影响；然而，添加孕激素会减弱与脂质相关的作用。减弱作用最小的孕激素是微粒化孕酮。与口服雌激素相比，经皮雌激素对凝血、炎症和脂质的影响较小，观察性研究表明，与口服雌激素相比，经皮雌激素导致静脉血栓栓塞和中风的风险更低。激素的临床效果并非始终呈剂量依赖性。
尽管HT在绝经管理中仍发挥重要作用，但不推荐用于原发性或继发性心血管疾病预防。HT的不同制剂、剂量和给药途径对心脏代谢标志物和临床心血管疾病事件风险有不同影响。然而，评估经皮和其他替代HT方案临床结局的长期试验有限。
