| Abstrakt: |
Professor Windler described the population data on cardiovascular disease (CVD) in women and the results of the CORA study conducted in Hamburg, Germany. CVD and stroke constitute much greater population risks than cancer. The determinant of obesity and subsequent myocardial infarction (MI) in older women appears to be the weight gain which occurs between age 20 and 40. Metabolic syndrome is characterized by insulin resistance (not necessarily diabetes). In Germany, only half of type II diabetics are actually diagnosed, whereas insulin resistance is not detected at all. Smoking is not an independent risk factor for CVD, according to the CORA study. It is not the smoking, but smoking in combination with some other factor, primarily hypertension. Although two-thirds of Japanese smoke, their MI rates are very low. The WHI results show that HRT may counteract insulin resistance. In the HERS study, no increased or decreased risk of CVD was found for HRT. An increase in risk was found in the first few months, however, which has also been found in the Nurse's Health study (Grodstein 2000). It should be noted that the WHI included only asymptomatic women and therefore does not reflect the treatment population. In HERS, women who receive HRT and have high lipids and then receive a statin had no increase in CVD risk compared with those who did not receive statins. In the CORA study, HRT users in general have a healthier lifestyle than non-users. The small group of HRT users who acquire disease in CORA have a high risk profile. Arteriosclerotic cardiovascular disease has become the major cause of death for women. Despite the increase in risk at the time of menopause, oestrogen deficit is certainly not the only responsible factor, since during the same period the incidence of classical risk factors increases dramatically. Typically women gain most of their weight even before menopause and develop a metabolic syndrome as a common risk profile, with the important elements of prevention being healthy nutrition and physical activity. The effects of oestrogens are so diverse that results of studies on elderly women or patients with coronary artery disease cannot be generalized. Unfortunately, intervention studies on the effects of hormone replacement therapy in women at the critical age of perimenopause are lacking. However, the data of the Women's Health Initiative (WHI) do not point to an increased risk in this phase. The Heart and Estrogen/Progestin Replacement Study (HERS) supports the notion that women even with coronary artery disease are not at increased risk given adequate medical treatment. Still, before starting hormone replacement therapy a predisposition for thromboembolic events should be excluded and blood pressure, blood sugar and lipids should be checked and treatment initiated, if necessary. As part of comprehensive medical care, low-dose oestrogens remain an effective and safe mainstay for the relief of perimenopausal symptoms. [ABSTRACT FROM AUTHOR] |
