Менопаузальная гормональная терапия и риск ишемической болезни сердца

Юренева С.В., Ильина Л.М.

1ФБГУ Научный центр акушерства, гинекологии и перинатологии им. академика В.И. Кулакова Минздрава России, Москва 2Ассоциация гинекологов-эндокринологов, Москва, Россия
Цель исследования. Провести анализ имеющихся в современной литературе данных о влиянии менопаузальной гормональной терапии (МГТ) на риск ишемической болезни сердца (ИБС) в постменопаузе.
Материал и методы. В обзор включены данные зарубежных и отечественных статей, найденных в Pubmed по данной теме и опубликованных в основном за последние 5 лет.
Результаты. Описаны отличия проявлений ИБС у женщин по сравнению с мужчинами, сердечно-сосудистые преимущества МГТ и современный взгляд на ее характеристики в свете баланса пользы и рисков.
Заключение. МГТ не является стандартной терапией для любой женщины и ее сердечно-сосудистые риски могут быть минимальными, а преимущества – максимальными при выборе оптимального режима терапии.

Ключевые слова

постменопауза
ишемическая болезнь сердца
менопаузальная гормональная терапия
баланс пользы/рисков

Список литературы

1. Wang H., Dwyer-Lindgren L., Lofgren K.T., Rajaratnam J.K., Marcus J.R., Levin-Rector A. et al. Age-specific and sex-specific mortality in 187 countries, 1970-2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012; 380(9859): 2071-94.

2. Perk J., De Backer G., Gohlke H., Graham I., Reiner Z., Verschuren M. et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur. Heart J. 2012; 33(13): 1635-701.

3. Anand S.S., Islam S., Rosengren A., Franzosi M.G., Steyn K., Yusufali A.H. et al. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur. Heart J. 2008; 29(7): 932-40.

4. Elias-Smale S.E., Günal A., Maas A.H. Gynecardiology: Distinct patterns of ischemic heart disease in middle-aged women. Maturitas. 2015; 81(3): 348-52.

5. Mosca L., Benjamin E.J., Berra K., Bezanson J.L., Dolor R.J., Lloyd-Jones D.M. et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: a guideline from the American Heart Association. Circulation. 2011; 123(11): 1243-62.

6. Mehta L.S., Beckie T.M., DeVon H.A., Grines C.L., Krumholz H.M., Johnson M.N. et al. Acute myocardial infarction in women: A scientific statement from the American Heart Association. Circulation. 2016; 133(9): 916-47.

7. Falk E., Nakano M., Bentzon J.F., Finn A.V., Virmani R. Update on acute coronary syndromes: the pathologists’ view. Eur. Heart J. 2013; 34(10): 719-28.

8. Grodstein F., Stampfer M.J., Manson J.E., Colditz G.A., Willett W.C., Rosner B. et al. Postmenopausal estrogen and progestin use and the risk of cardiovascular disease. N. Engl. J. Med. 1996; 335(7): 453-61.

9. Rossouw J.E., Anderson G.L., Prentice R.L., LaCroix A.Z., Kooperberg C., Stefanick M.L. et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002; 288(3): 321-33.

10. Hulley S., Grady D., Bush T., Furberg C., Herrington D., Riggs B., Vittinghoff E. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA. 1998; 280(7): 605-13.

11. Rossouw J.E., Prentice R.L., Manson J.E., Wu L., Barad D., Barnabei V.M. et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA. 2007; 297(13): 1465-77.

12. Manson J.E., Allison M.A., Rossouw J.E., Carr J.J., Langer R.D., Hsia J. et al. Estrogen therapy and coronary-artery calcification. N. Engl. J. Med. 2007; 356(25): 2591-602.

13. Gast G.C., Pop V.J., Samsioe G.N., Grobbee D.E., Nilsson P.M., Keyzer J.J. et al. Vasomotor menopausal symptoms are associated with increased risk of coronary heart disease. Menopause. 2011; 18(2): 146-51.

14. Herber-Gast G.C.M., Brown W.J., Mishra G.D. Hot flushes and night sweats are associated with coronary heart disease risk in midlife: a longitudinal study. BJOG. 2015; 122(11): 1560-7.

15. Manson J.E., Hsia J., Johnson K.C., Rossouw J.E., Assaf A.R., Lasser N.L. et al. Estrogen plus progestin and the risk of coronary heart disease. N. Engl. J. Med. 2003; 349(6): 523-34.

16. Hodis H.N., Mack W.J., Henderson V.W., Shoupe D., Budoff M.J., Hwang-Levine J. et al. Vascular effects of early versus late postmenopausal treatment with estradiol. N. Engl. J. Med. 2016; 374(13): 1221-31.

17. Nezarat N., Brumback L., Luo Y. et al. Timing of hormone replacement therapy and coronary artery calcium progression: The Multi-Ethnic study of Atherosclerosis. In: SCCT2016 -11th Annual Scientific Meeting of the Society of Cardiovascular Computed Tomography. June 23-26, 2016 Orlando, FL: abstr. 94.

18. Carr J.J., Jacobs D.R. Jr., Terry J.G., Shay C.M., Sidney S., Liu K. et al. Association of coronary artery calcium in adults 32 to 46 years with incident coronary heart disease and death. JAMA Cardiol. 2017; Feb 8. doi: 10.1001/jamacardio.2016.5493.

19. Bray P.F., Larson J.C., LaCroix A.Z., Manson J., Limacher M.C., Rossouw J.E. et al. Usefulness of baseline lipids and C-reactive protein in women receiving menopausal hormone therapy as predictors of treatment-related coronary events. Am. J. Cardiol. 2008; 101(11): 1599-605.

20. Franco O.H., Muka T., Colpani V., Kunutsor S., Chowdhury S., Chowdhury R., Kavousi M.Vasomotor symptoms in women and cardiovascular risk markers: systematic review and meta-analysis. Maturitas. 2015; 81(3):353-61.

21. Salpeter S.R., Walsh J.M., Greyber E., Salpeter E.E. Coronary heart disease events associated with hormone therapy in younger and older women. A meta-analysis. J. Gen. Intern. Med. 2006; 21(4): 363-6.

22. Manson J.E., Chlebowski R.T., Stefanick M.L., Aragaki A.K., Rossouw J.E., Prentice R.L. et al. Menopausal hormone therapy and health outcomes during the intervention and extended poststopping phases of the Women’s Health Initiative randomized trials. JAMA. 2013; 310(13):1353-68.

23. Mikkola T.S., Tuomikoski P., Lyytinen H., Korhonen P., Hoti F., Vattulainen P. et al. Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause. 2015; 22(9):976-83.

24. Schierbeck L.L., Rejnmark L., Tofteng C.L., Stilgren L., Eiken P., Mosekilde L. et al. Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ. 2012; 345: e6409.

25. Salpeter S.R., Ji Cheng, Thabane L., Buckley N.S., Salpeter E.E. Bayesian meta-analysis of hormone therapy and mortality in younger postmenopausal women. Am. J. Med. 2009; 122(11): 1016-22.

26. Boardman H.M., Hartley L., Eisinga A., Main C., Roqué i Figuls M., Bonfill Cosp X. et al. Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst. Rev. 2015; (3): CD002229.

27. Baber R.J., Panay N., Fenton A.; the IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016; 19(2): 109-50.

28. Dinger J., Bardenheuer K., Heinemann K. Drospirenone plus estradiol and the risk of serious cardiovascular events in postmenopausal women. Climacteric. 2016; 19(4): 349-56.

29. Lewington S., Clarke R., Qizilbash N., Peto R., Collins R.; Prospective Studies Collaboration. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002; 360(9349):1903-13.

30. Byrd J.B., Brook R.D. A critical review of the evidence supporting aldosterone in the etiology and its blockade in the treatment of obesity-associated hypertension. J. Hum. Hypertens. 2014; 28(1): 3-9.

31. Caprio M., Antelmi A., Chetrite G., Muscat A., Mammi C., Marzolla V. et al. Antiadipogenic effects of the mineralocorticoid receptor antagonist drospirenone: potential implications for the treatment of metabolic syndrome. Endocrinology. 2011; 152(1): 113-25.

32. De Franciscis P., Mainini G., Labriola D., Leo S., Santangelo F., Luisi A. et al. Low-dose estrogen and drospirenone combination: effects on metabolism and endothelial function in postmenopausal women with metabolic syndrome. Clin. Exp. Obstet. Gynecol. 2013; 40(2):233-5.

33. Rizzo M.R., Leo S., De Franciscis P., Colacurci N., Paolisso G. Short-term effects of low-dose estrogen/drospirenone vs low-dose estrogen/dydrogesterone on glycemic fluctuations in postmenopausal women with metabolic syndrome. Age. 2014; 36(1): 265-74.

34. Rossouw J.E., Manson J.E., Kaunitz A.M., Anderson G.L. Lessons learned from the Women’s Health Initiative trials of menopausal hormone therapy. Obstet. Gynecol. 2013; 121(1): 172-6.

35. Shifren J.L., Gass M.L.; NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society recommendations for clinical are of midlife women. Menopause. 2014; 21(10): 1038-62.

36. Stuenkel C.A., Davis S.R., Gompel A., Lumsden M.A., Murad M.H., Pinkerton J.V., Santen R.J. Treatment of symptoms of the menopause: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2015; 100(11): 3975-4011.

37. de Villiers T.J., Hall J.E., Pinkerton J.V., Cerdas Pérez S., Rees M., Yang C., Pierroz D.D. Revised global consensus statement on menopausal hormone therapy. Climacteric. 2016; 19(4): 313-5.

38. Gass M.L., Maki P.M., Shifren J.L., Schnatz P.F., Kaunitz A.M., Shapiro M., Sievert L.L. NAMS supports judicious use of systemic hormone therapy for women aged 65 years and older. Menopause. 2015; 22(7): 685-6.

39. Freeman E.W., Sammel M.D., Sanders R.J. Risk of long-term hot flashes after natural menopause: evidence from the Penn Ovarian Aging Study cohort. Menopause. 2014; 21(9): 924-32.

40. Avis N.E., Crawford S.L., Greendale G. et al.; the Study of Women’s Health Across the Nation (SWAN). Duration of menopausal vasomotor symptoms over the menopause transition. JAMA Intern. Med. 2015; 175(4): 531-9.

41. Gartoulla P., Worsley R., Bell R.J., Davis S.R. Moderate to severe vasomotor and sexual symptoms remain problematic for women aged 60 to 65 years. Menopause. 2015; 22(7): 694-701.

42. Aslan E., Bagis T., Kilicdag E.B., Tarim E., Erkanli S., Kuscu E. How best is to discontinue postmenopausal hormone therapy: immediate or tapered? Maturitas. 2007; 56(1): 78-8.

43. Haskell S.G., Bean-Mayberry B., Gordon K. Discontinuing postmenopausal hormone therapy: an observational study of tapering versus quitting cold turkey: is there a difference in recurrence of menopausal symptoms? Menopause. 2009; 16(3): 494-9.

44. Suffoletto J.A., Hess R. Tapering versus cold turkey: symptoms versus successful discontinuation of menopausal hormone therapy. Menopause. 2009; 16(3): 436-7.

45. National Institute for Health and Clinical Excellence. NICE Clinical Guideline Menopause. 2015. Available at: https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and-management-1837330217413

46. Mikkola T.S., Tuomikoski P., Lyytinen H., Korhonen P., Hoti F., Vattulainen P. et al. Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J. Clin. Endocrinol. Metab. 2015; 100(12): 4588-94.

47. Lantto H., Mikkola T.S., Tuomikoski P., Viitasalo M., Väänänen H., Sovijärvi A.R., Haapalahti P. Cardiac repolarization in recently postmenopausal women with or without hot flushes. Menopause. 2016; 23(5): 528-34.

48. Buber J., Mathew J., Moss A.J., Hall W.J., Barsheshet A., McNitt S. et al. Risk of recurrent cardiac events after onset of menopause in women with congenital long-QT syndrome types 1 and 2. Circulation. 2011; 123(24): 2784-91.

49. Mikkola T.S., Savolainen-Peltonen H., Venetkoski M., Ylikorkala O. New evidence for cardiac benefit of postmenopausal hormone therapy Climacteric. 2017; 20(1): 5-10.

Поступила 07.02.2017

Принята в печать 17.02.2017

Об авторах / Для корреспонденции

Юренева Светлана Владимировна, д.м.н., в.н.с. отделения гинекологической эндокринологии ФГБУ НЦАГиП им. В.И. Кулакова Минздрава России.
Адрес: 1179976, Россия, Москва, ул. Академика Опарина, д. 4. Телефон: 8 (916) 179-74-00. E-mail: syureneva@gmail.com
Ильина Лилия Михайловна, к.м.н., секретарь Ассоциации гинекологов-эндокринологов.
Адрес: 1179976, Россия, Москва, ул. Академика Опарина, д. 4. Телефон: 8 (915) 210-19-31. E-mail: bseiljina@mail.ru

Для цитирования: Юренева С.В., Ильина Л.М. Менопаузальная гормональная терапия и риск ишемической болезни сердца. Акушерство и гинекология. 2017; 3: 42-9.
http://dx.doi.org/10.18565/aig.2017.3.42-9

Также по теме

Продолжая использовать наш сайт, вы даете согласие на обработку файлов cookie, которые обеспечивают правильную работу сайта.