Особенности факторов риска сердечно-сосудистых заболеваний у женщин и роль половых гормонов
Аннотация
Несмотря на определенные успехи, достигнутые в последние годы, проблема сердечно-сосудистых заболеваний (ССЗ) у женщин остается одним из главных вызовов 21 века, социально-экономическое бремя которой будет возрастать в связи с резким увеличением числа женщин старшего возраста. В последние годы кардиологи все больше внимания стали уделять менопаузе, как специфическому фактору риска ССЗ у женщин. Однако определенным осложнениям беременности, преждевременному “выключению” функции яичников, также способствующим повышению риска сердечно-сосудистых событий в последующие годы, не придается должного значения. Несомненно, заместительная гормональная терапия остается терапией первой линии и самым эффективным методом лечения эстрогенного дефицита у молодых женщин и менопаузальных симптомов в постменопаузе; залогом ее эффективности и безопасности являются правильные сроки назначения, низкая доза и подходящая для конкретной пациентки комбинация эстрогенов/прогестинов. Междисциплинарный подход крайне важен для своевременного выявления женщин с повышенным риском, поскольку предоставление им рекомендаций по изменению образа жизни, проведение необходимых диагностических процедур и, в случае необходимости, активное терапевтическое вмешательство будут содействовать сокращению риска ССЗ у этих женщин в последующем.
Об авторах
С. В. Юренева
ФГУ Научный центр акушерства, гинекологии и перинатологии им. В.И. Кулакова Минздравсоцразвития
Россия
Россия
ведущий научный сотрудник
Москва
В. Б. Мычка
Институт клинической кардиологии им. А.Л. Мясникова ФГУ РКНПК Минздравсоцразвития России
Россия
Россия
ведущий научный сотрудник отдела системных гипертензий
Москва
Л. М. Ильина
Ассоциация гинекологов-эндокринологов
Россия
Россия
к.м.н., секретарь
Москва
С. Н. Толстов
МУЗ 1-я Городская клиническая больница им. Ю.Я. Гордеева
Россия
Россия
заведующий кардиологическим отделением
Саратов
Список литературы
1. Mosca L, Mochari-Greenberger H, Dolor RJ, et al. Twelve-year follow-up of American women’s awareness of cardiovascular disease risk and barriers to heart health. Circ Cardiovasc Qual Outcomes 2010; 3: 120-7.
2. Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of CVD in women-2011 update. A guideline from the American Heart Association Circulation 2011; 123: DOI:10.1161/CIR.0b013e31820faaf8
3. Xu JQ, Kochanek KD, Murphy SL, B. T-V. Deaths: Final Data for 2007: National Vital Statistics Reports. Hyattsville, MD: National Center for Health Statistics; 2010
4. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N Engl J Med 2007; 356: 2388-98.
5. Rossouw JE, Anderson GL, Prentice RL, et al. Writing Group for the Women’s Health Initiative Investigators. 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: 321-33.
6. Stramba-Badiale M, Fox KM, Priori SG, et al. Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology. Eur Heart J 2006; 27: 994-1005.
7. Collins P, Rosano G, Casey C, et al. Management of cardiovascular risk in the perimenopausal women: a consensus statement of European cardiologist and gynaecologist. Eur Heart J 2007; 28: 2028-4.
8. Сметник В.П., Балан В.Е, Зайдиева Я.З. и др. Ведение женщин с сердечно-сосудистым риском в пери- и постменопаузе. РКЖ 2008; 4: 40-57.
9. The Writing Group on behalf of the Workshop Consensus Group. Aging, menopause, cardiovascular disease and HRT. Climacteric 2009; 12: 368-77.
10. Мычка В.Б., Кузнецова И.В., Кириллова М.Ю. и др. Женский вопрос в кардиологии. Кардиоваск тер профил 2010; 9(4): 71-80.
11. Roger VL, Go AS, Lloyd-Jones DM, et аl.; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics-2011 update: a report from the American Heart Association. Circulation 2011; 123: e18-209.
12. Heidenreich PA, Trogdon JG, Khavjou OA, et al. Forecasting the Future of Cardiovascular Disease in the United States: A Policy Statement From the American Heart Association. Circulation 2011; 123: 00-00 [Epub ahead of print] DOI:10.1161/CIR.0b013e31820a55f5. Available at: http://circ.ahajournals.org
13. van der Schouw YT. Incidence and mortality of cardiovascular disease in postmenopausal women world-wide and relevance for preventive strategies. Climacteric 2009; 12(Suppl 1): 1-5.
14. Hu G, Jousilahti P, Qiao Q, et al. The gender-specific impact of diabetes mellitus and myocardial infarction at baseline and during follow-up on mortality from all causes and coronary heart disease. JACC 2005; 45: 1413-8.
15. Kssja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA 2005; 294: 2751-7.
16. Duley L. The global impact of pre-eclampsia. Semin Perinatol 2009; 33: 130-7.
17. Wilson BJ, Watson MS, Prescott GJ, et al. Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study. BMJ 2003; 326: 845.
18. Ray JC, Vermeulen MJ, Dchull MJ, et al. Cardiovascular Health After Maternal Placental Syndromes (CHAMPS): populationbased retrospective cohort study Lancet 2005;356:1797-803
19. Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335: 974.
20. Garovic VD, Hayman SR. Hypertension in pregnancy: an emerging risk factor for cardiovascular disease. Nat Clin Pract Nephrol 2007; 3: 613-22.
21. Carpenter MW. Gestational diabetes, pregnancy hypertension, and late vascular disease. Diabetes Care 2007; 30(Suppl 2): 246-50.
22. Rodie VA, Freeman DJ, Sattar N, Greert IA. Pre-eclampsia and cardiovascular disease: metabolic sybdrom of pregnancy? Atherosclerosis 2004; 175: 189-202.
23. Lykke JA, Langhoff-Roos J, Sibai BM, et al. Hypewrtensive pregnancy didorders and subsequent cardiovascular morbidity and type 2 diabetes mellitus in the mother. Hypertension 2009; 53: 944-51.
24. Smith GC, Wood AM, White IR, et al. Birth weight and the risk of cardiovascular disease in the maternal grandparents. Am J Epidemiol 2010; 171: 736-44.
25. Carmina E. Cardiovascular risk and events in polycystic ovary syndrome Climacteric 2009; 12 (Suppl 1): 22-5.
26. Rivera CM, Grossardt BR, Rhodes DJ, et al. Increased cardiovascular mortality after early bilateral oophorectomy. Menopause 2009; 16: 15-23.
27. Vujovic S, Brincat M, Erel T, et al. EMAS position statement: Managing women with premature ovarian failure. Maturitas 2010; 67: 91-3.
28. Bairey Merz C N, Johnson B D, Sharaf BL, et al. Hypoestrogenemia of Hypothalamic Origin and Coronary Artery Disease in Premenopausal Women: A Report from the NHLBISponsored WISE Study. JACC 2003; 41: 413-9.
29. Ingelsson E, Lundholm C, Johansson AL, Altman D. Hysterectomy and risk of cardiovascular disease: a population based cohort study. Eur Heart J 2010; Dec 24. [Epub ahead of print]
30. Parker WH, Broder MS, Chang E, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study. Obstet Gynecol 2009; 113: 1027-37.
31. Rosano G М, Vitale C, Tulli A. Managing cardiovascular risk in menopausal women. Climacteric 2006;9 (Suppl 1): 19-27.
32. Boggia J, Thijs L, Hansen TW, et al. Ambulatory Blood Pressure Monitoring in 9357 Subjects From 11 Populations Highlights Missed Opportunities for Cardiovascular Prevention in Women. Hypertension 2011. Published online before print January 24, 2011, doi: 10.1161/HYPERTENSIONAHA.110.156828
33. Gast G-C M, Pop V JM, Samsioe GN, et al. Vasomotor menopausal symptoms are associated with increased risk of coronary heart disease. Menopause 2011;18(2): 146-51.
34. Thurston RC, Sutton-Tyrrell K, Everson-Rose SA, et al. Hot flashes and subclinical cardiovascular disease: findings from the Study of Women’s Health Across the Nation Heart Study. Circulation 2008; 118: 1234-40.
35. Gambacciani М, Pepe А. Vasomotor symptoms and cardiovascular risk. Climacteric 2009; (Suppl 1): 32-5.
36. Simoncini T. Mechanisms of action of estrogen receptors in vascular cells: relevance for menopause and aging. Climacteric 2009; 12 (Suppl 1): 6-11.
37. Mendelsohn ME. Estrogen actions in the cardiovascular system. Climacteric 2009; 12 (Suppl 1): 18-21.
38. International Menopause Society. IMS Updated Recommendations on postmenopausal hormone therapy. Climacteric 2007; 10: 181-94.
39. Archer DF, Arnal J-F, Birkhauser M, et al. Aging, menopause, cardiovascular disease and HRT. International Menopause Society Consensus Statement. The Writing Group on behalf of the Workshop Consensus Group. Climacteric 2009; 12: 368-77.
40. North American Menopause Society. Estrogen and progestogen use in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010; 17: 242-55.
41. Hodis HN, Mack WJ. Coronary heart disease and hormone replacement therapy after menopause. Climacteric 2009; 12 (Suppl 1): 71-5.
42. Salpeter SR, Walsh JM, Greyber E, Salpeter EE. Coronary heart disease events associated with hormone therapy in younger and older women: a meta-analysis. J Gen Intern Med 2006; 21: 363-6.
43. Salpeter SR, Walsh JME, Greyber E, et al. Mortality associated with hormone replacement therapy in younger and older women: a meta-analysis. J Gen Intern Med 2004; 19: 791-804.
44. Rossouw JE, Prentice RL, Manson JA, et al. Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA 2007; 297: 1465-77.
45. Oelkers W. Drospirenone, a progestogen with antimineralocorticoid properties: a short review. Molecular and Cellular Endocrinology 2004; 217: 255-61.
46. White WB, Pitt B, Preston RA, Hanes V. Antihypertensive effects of drospirenone with 17-beta-estradiol, a novel hormone treatment in post-menopausal women with stage 1 hypertension. Circulation 2005; 112: 1979-84.
47. Preston RA, White WB, Pitt B, et al. Effects of drospirenone/17-beta estradiol on blood pressure and potassium balance in hypertensive postmenopausal women. Am J Hypertens 2005; 18: 797-804.
48. Preston RA, Norris PM, Alonso AB, et al. Randomized, placebocontrolled, trial of the effects of drospirenone-estradiol on blood pressure and potassium balance in hypertensive postmenopausal women receiving hydrochlorothiazide. Menopause 2007; 14: 408-14.
49. Women’s Health Initiative Steering Committee. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA 2004; 291: 1701-12.
50. Hsia J, Langer RD, Manson JE, et al. Conjugated equine estrogens and coronary disease. Arch Intern Med 2006; 166: 357-65.
51. Manson JE, Hsia J, Johnson KC, et al. Estrogen plus progestin and the risk of coronary heart disease. N Engl J Med 2003; 349: 523-34.
52. Pines A, Sturdee DW, Birkhaßuser MH, et al. Summary of the First IMS Global Summit on menopause-related issues, HRT in the early menopause: scientific evidence and common perceptions. Climacteric 2008; 11: 267-72.
53. Canonico M, Oger E, Plu-Bureau G, et al. for the Estrogen and Thromboembolism Risk (ESTHER) Study Group. Hormone therapy and venous thromboembolism among postmenopausal women: impact of the route of estrogen administration and progestogens: the ESTHER Study. Circulation 2007; 115: 840-5.
54. Archer DF, Thorneycroft IH, Foegh M, et al. Long-term safety of drospirenone-estradiol for hormone therapy: a randomized, double-blind, multicenter trial. Menopause 2005; 12: 716-27.
55. Cimoncini T, Fu A, Caruso S, et al. Drospirenone increases endothelial nitric oxide synthesis via a combined action on progesterone and mineralocorticoid receptors Human Reprod 2007; 22 (8): 2325-34.
56. Seeger H, Wallwiener D, Mueck AO; Effects of drospirenone on cardiovascular markers in human aortic endothelial cells. Climacteric 2009; 12: 80-7.
57. Knuuiti J, Kallokoski R, Janatuinen T, et al. Effect of estradioldrospirenone hormone treatment on myocardial perfusion reserve in postmenopausal women with angina pectoris Am J Cardiol 2007; 99: 1648-52.
58. Адашева Т.В., Задионченко В.С., Порывкина О.Н. и др. Терапевтические аспекты применения заместительной гормональной терапии у пациенток с метаболическим синдромом в постменопаузе — взгляд кардиолога. Кардиоваск тер профил 2009; 8: 49-55.
59. Tanko LB, Christiansen C. Effects of 17b-oestradiol plus different doses of drospirenone on adipose tissue, adiponectin and atherogenic metabolites in postmenopausal women. J Intern Med 2005; 258: 544-53.
60. Ведение женщин в пери- и постменопаузе. Практические рекомендации Российской ассоциации по менопаузе. Москва 2010.
Для цитирования:
Юренева С.В., Мычка В.Б., Ильина Л.М., Толстов С.Н. Особенности факторов риска сердечно-сосудистых заболеваний у женщин и роль половых гормонов. Кардиоваскулярная терапия и профилактика. 2011;10(4):128-135. https://doi.org/10.15829/1728-8800-2011-4-128-135
For citation:
Yureneva S.V., Mychka V.B., Ilyina L.M., Tolstov S.N. Cardiovascular risk factors in women and the role of sex hormones. Cardiovascular Therapy and Prevention. 2011;10(4):128-135. (In Russ.) https://doi.org/10.15829/1728-8800-2011-4-128-135
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