文档介绍：Estrogen Replacement Therapy and the Prevention of Coronary Heart Disease in Women:
Friend or Foe?
David Parra,
95
Years
Deaths in Thousands
Males
Females
Cardiovascular Disease Mortality Trends
United States 1995 Mortality Data
Adapted from 1998 Heart and Stroke Statistical Update, AHA.
Premenopausal Postmenopausal
Decrease in HDL
Increase in LDL, triglycerides, apolipoproteins B and A-I
Increase in diastolic blood pressure
Menopause exerts a negative effect on CHD risk
Incidence of Coronary Heart Disease
0
2
4
6
8
10
12
14
16
Annual rate per
1000 subjects
.
Clinical Coronary
Artery Disease
Women age 35-64
Women age 65-94
Framingham Cohort
Adapted from Kannel et. al. American Heart Journal. 1987;114:413-9.
The Framingham Heart Study Annual Rate of Coronary Artery Disease in Women as a Function of Age
Number cases/1000
0
5
10
15
20
25
30
35
40
45
patients per year
35-44
45-54
55-64
65--74
75-84
85-94
Age (years)
Adapted from Castelli et al. Am J Obstet Gynecol 1988; 158: 1553-60.
20-29
30-39
40-49
50-59
60-69
70-79
> 80
11
0
5
10
15
20
25
Ages
Adapted from 1998 Heart and Stroke Statistical Update, AHA.
Estimated Prevalence of CHD in Women by Age
United States 1988-91
Percent Female Population
Early Outcome of Acute Myocardial Infarction - ISIS-3
0
5
10
15
20
25
% Patients
<60
60-69
>70
Any age
Age (years)
35-Day Mortality
Women
Men
Adapted from Malacrida R et. al. N Eng J Med. 1998;338:8-14.
Premenopausal Postmenopausal
Loss of endogenous estradiol production
Presumption estrogen has a role in premenopausal protection against CHD
Conversely its loss has a role in postmenopausal risk
Estrogen replacement therapy (ERT) should decrease this risk by maintaining metabolic factors that affect CHD at premenopausal levels
Estrogens Cardioprotective
Mechanisms
Lipids/Atheroma
Antioxidant
Hemostatic/Plate