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Background. Hormonal replacement therapy (HRT) after menopause can affect cardiovascular system in a positive and negative way. Positive effects are exerted through estrogenic action on metabolic risk factors, such as Iipids, glucose and insulin metabolism, as well as direct arterial effects, reducing atherogenesis. Negative effects are dose-dependent transient increase in coagulation activation and adverse vascular remodelling. Observational studies suggested that HRT might have a beneficial effect on the incidence of coronary heart disease, which is not in Iine with later randomized clinical trials. The main difference between both types of the studies is that participants in observational trials were in their fifties and in average ten years younger compared to randomized trials. Post-hoc analysis of the Women's Health Initiative trial found a trend toward cardioprotective HRT in younger patients. Conclusions. HRT is currently not recommended for the primary coronary prevention. But in women with menopausal symptoms, which are at the initiation of HRT younger than 60 years and are less than 10 years after menopause. HRT does seem not to increase cardiovascular events. Initiation of HRT early after menopause may reduce cardiovascular risk. Izhodišča. Hormonsko nadomestno zdravljenje (HNZ) po menopavzi ima lahko pozitiven ali negativen učinek na srčno-žilni sistem. Pozitiven vpliv predstavlja ugoden učinek HNZ na presnovo lipidov, krvnega sladkorja in inzulina, kot tudi ugoden neposredni vpliv na arterijsko žilno steno pri zaviranju procesa ateroskleroze. Negativni vpliv je povezan s prehodnim spodbujanjem koagulacije in neugodnim učinkom na preoblikovanje žilne stene, kar je odvisno od odmerka hormonov HNZ. Izsledki opazovalnih raziskav kažejo na ugoden vpliv HNZ na pojavnost srčno-žilnih bolezni (SŽB), kar ni v soglasju s kasnejšimi randomiziranimi kliničnimi raziskavami. Glavna razlika med obema vrstama raziskav je v starosti. Preiskovanke, ki so sodelovale v opazovalnih raziskavah, so bile v povprečju za več kot 10 let mlajše od tistih, ki so sodelovale v randomiziranih raziskavah. Ponovne analize Women's Health Initiative so pokazale trend zaščitnega vpliva na srčno-žilni sistem tudi pri mlajši starostni skupini. Zaključki. HNZ ni indicirano za preprečevanje SŽB pri ženskah po menopavzi. HNZ pri ženskah v perimenopavzi ali zgodaj po menopavzi, ki imajo menopavzne težave, so ob začetku HNZ mlajše od 60 let in so manj kot 10 let od menopavze, tveganja za SŽB ne poveča, morda celo zmanjša tveganje za koronarno bolezen srca. |
