Anagnostis Panagiotis, Stevenson John C
Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London SW3 6NP, UK.
Best Pract Res Clin Endocrinol Metab. 2024 Jan;38(1):101781. doi: 10.1016/j.beem.2023.101781. Epub 2023 Apr 25.
Estrogen depletion following menopause predisposes to increased risk of cardiovascular disease (CVD), mainly due to ischemic heart disease. This is mostly evident in cases with premature menopause. The pathophysiological basis for this atherosclerotic process is the accumulation of several risk factors, such as abdominal obesity, atherogenic dyslipidemia, insulin resistance and arterial hypertension. The presence of vasomotor symptoms may further augment this risk, especially in women younger than 60 years. Menopausal hormone therapy (MHT) exerts many beneficial effects on lipid profile and glucose homeostasis as well as direct arterial effects, and may reduce CVD risk if initiated promptly (i.e.,<60 years or within ten years of the final menstrual period). Transdermal estradiol and micronized progesterone or dydrogesterone are the safest regimens in terms of venous thromboembolic events (VTE) and breast cancer risk. In any case, an individualized approach, taking into account the patient's total CVD, VTE and breast cancer risk, is recommended.
绝经后雌激素缺乏会增加心血管疾病（CVD）风险，主要是由于缺血性心脏病。这在过早绝经的病例中最为明显。这种动脉粥样硬化过程的病理生理基础是多种风险因素的积累，如腹型肥胖、致动脉粥样硬化血脂异常、胰岛素抵抗和动脉高血压。血管舒缩症状的存在可能会进一步增加这种风险，尤其是在60岁以下的女性中。绝经激素治疗（MHT）对血脂谱和葡萄糖稳态以及动脉有直接有益作用，如果及时开始（即60岁以下或在最后一次月经后的十年内），可能会降低CVD风险。就静脉血栓栓塞事件（VTE）和乳腺癌风险而言，经皮雌二醇与微粉化孕酮或地屈孕酮是最安全的方案。无论如何，建议采用个体化方法，考虑患者总的CVD、VTE和乳腺癌风险。
