Departments of Medicine, Obstetrics & Gynecology, and Epidemiology, University of Michigan, Ann Arbor, MI, USA.
Diabetes Metab J. 2021 Jul;45(4):492-501. doi: 10.4093/dmj.2020.0262. Epub 2021 Jul 30.
Cardiovascular disease is the primary cause of mortality in women and men with diabetes. Due to age and worsening of risk factors over the menopausal transition, risk of coronary heart disease events increases in postmenopausal women with diabetes. Randomized studies have conflicted regarding the beneficial impact of estrogen therapy upon intermediate cardiovascular disease markers and events. Therefore, estrogen therapy is not currently recommended for indications other than symptom management. However, for women at low risk of adverse events, estrogen therapy can be used to minimize menopausal symptoms. The risk of adverse events can be estimated using risk engines for the calculation of cardiovascular risk and breast cancer risk in conjunction with screening tools such as mammography. Use of estrogen therapy, statins, and anti-platelet agents can be guided by such calculators particularly for younger women with diabetes. Risk management remains focused upon lifestyle behaviors and achieving optimal levels of cardiovascular risk factors, including lipids, glucose, and blood pressure. Use of pharmacologic therapies to address these risk factors, particularly specific hypoglycemic agents, may provide some additional benefit for risk prevention. The minimal benefit for women with limited life expectancy and risk of complications with intensive therapy should also be considered.
心血管疾病是糖尿病患者男女死亡的主要原因。由于绝经过渡期间年龄的增长和风险因素的恶化，患有糖尿病的绝经后女性发生冠心病事件的风险增加。随机研究对于雌激素治疗对中间心血管疾病标志物和事件的有益影响存在冲突。因此，雌激素治疗目前不推荐用于除症状管理以外的适应症。然而，对于发生不良事件风险较低的女性，雌激素治疗可用于最大限度地减少绝经症状。可以使用风险引擎来估计不良事件的风险，以计算心血管风险和乳腺癌风险，并结合乳房 X 线摄影等筛查工具。特别是对于年轻的糖尿病女性，可以使用此类计算器来指导雌激素治疗、他汀类药物和抗血小板药物的使用。风险管理仍然侧重于生活方式行为和实现心血管风险因素（包括血脂、血糖和血压）的最佳水平。使用药物治疗来解决这些风险因素，特别是特定的降血糖药物，可能会为预防风险提供一些额外的益处。对于预期寿命有限且强化治疗有并发症风险的女性，也应考虑最小的益处。
