Barrett-Connor E, Miller V
Department of Community and Family Medicine (0607), University of California, San Diego, La Jolla 92093.
Clin Geriatr Med. 1993 Feb;9(1):57-67.
The routine prescription of hormone replacement therapy for elderly women to prevent heart disease is not indicated. Until better data are available, the use of estrogens primarily to prevent heart disease probably should be reserved for women at high risk by virtue of their LDL/HDL ratio or the presence of manifest coronary heart disease. There is no reason to give progestins to the woman without a uterus; unopposed oral estrogen should improve lipoproteins within a few weeks, and this change, if sustained, should reduce risk. The management of a woman with an intact uterus is more problematic given the unknowns about progestin's long-term effects on lipids or the heart and the unwillingness of many elderly women to resume regular (or irregular) bleeding. There are, however, many proven benefits of hormone replacement therapy, including the prevention of osteoporosis and urogenital atrophy. Decisions about when it is too late to start estrogen, or when it is time to stop it, will need to be made on a case-by-case basis.
不建议对老年女性常规开具激素替代疗法以预防心脏病。在获得更好的数据之前，主要为预防心脏病而使用雌激素或许应仅限于因低密度脂蛋白/高密度脂蛋白比例或存在明显冠心病而处于高风险的女性。对于没有子宫的女性，没有理由给予孕激素；无对抗的口服雌激素应在几周内改善脂蛋白水平，而且这种变化如果持续，应能降低风险。鉴于孕激素对脂质或心脏的长期影响尚不清楚，以及许多老年女性不愿恢复规律（或不规律）出血，对于子宫完整的女性的管理更具问题。然而，激素替代疗法有许多已证实的益处，包括预防骨质疏松症和泌尿生殖系统萎缩。关于何时开始雌激素治疗已为时过晚，或何时应停止治疗，需要根据具体情况做出决定。
