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首页> 美国卫生研究院文献>other >The timing hypothesis: Do coronary risks of menopausal hormone therapy vary by age or time since menopause onset?
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The timing hypothesis: Do coronary risks of menopausal hormone therapy vary by age or time since menopause onset?

机译：时间假设：更年期发生后绝经激素治疗的冠状动脉风险是否随年龄或时间而变化？

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摘要

The Women’s Health Initiative (WHI), a landmark randomized trial of menopausal hormone therapy (HT) for prevention of chronic disease in postmenopausal women aged 50–79, established that such therapy neither prevents coronary heart disease (CHD) nor yields a favorable balance of benefits and risks in such women as a whole. However, a nuanced look at the data from this trial, considered alongside other evidence, suggests that timing of HT initiation affects the relation between such therapy and coronary risk, as well as its overall benefit-risk balance. Estrogen may have a beneficial effect on the heart if started in early menopause, when a woman’s arteries are likely to be relatively healthy, but a harmful effect if started in late menopause, when those arteries are more likely to show signs of atherosclerotic disease. However, even if HT-associated relative risks are constant across age or time since menopause onset, the low absolute risk of CHD in younger or recently menopausal women translates into low attributable risks in this group. Thus, HT initiation for relief of moderate to severe vasomotor symptoms in early menopausal patients who have a favorable coronary profile remains a viable option.(WHI clinicaltrials.gov identifier: )
机译：妇女健康倡议（WHI）是一项更有意义的随机试验，旨在预防50-79岁的绝经后妇女中的慢性疾病，绝经激素疗法（HT）既不能预防冠心病（CHD），也不能产生良好的平衡。这些妇女作为一个整体的利益和风险。然而，对这项试验数据的细微观察与其他证据一起考虑，表明HT起始时间会影响这种疗法与冠心病风险之间的关系，以及其整体获益风险平衡。如果女性的动脉可能在更年期开始时就开始相对健康，则雌激素可能会对心脏产生有益的影响；而如果更年期的晚期开始时就更容易出现动脉粥样硬化疾病的迹象，则雌激素可能会对心脏产生有益的影响。但是，即使自绝经开始以来，与HT相关的相对风险在各个年龄段或一段时间内都保持不变，但年轻或新近绝经的妇女中冠心病的绝对风险较低，也意味着该人群的归因风险较低。因此，对于具有良好冠脉特征的绝经早期患者，HT疗法可缓解中度至重度血管舒缩症状仍然是可行的选择。（WHI Clinicaltrials.gov标识符:)

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