Nilgün Öztürk TURHAN, Serap SİMAVLI, İlknur İnegöl GÜMÜŞ

Postmenopozal hormon tedavisi kardiyovasküler hastalık riskini azaltıyor mu?

Kardiyovasküler hastalıklar (KVH) dünyada tüm kadın ve erkek ölümlerinde birinci nedendir. KVH riski erkeklerde üreme dönemindeki kadınlara oranla 2,5-4,5 kat daha fazla iken 50 yaşından sonra kadınlarda hızla erkeklerin risk seviyelerine ulaşır. Erken menopoza giren kadınlarda koroner arter hastalıkları riski normal yaşta menopoza giren kadınlara göre daha yüksektir. Orta yaş üzeri kadınlarda ölümlerin yaklaşık %46'sı KVH’lar nedeni ile olmaktadır. Premenopozal dönemde KVH görülme oranı az iken menopoz sonrası artış göstermesi overyan hormon eksikliğinin patofizyolojide anahtar rol aldığını düşündürmektedir. Gözlemsel çalışmalarda postmenopo-zal hormon tedavisinin (HT) kardiyovasküler hastalıklardan koruma sağladığı bildirilmesine karşın daha sonra yapılan randomize çalışmaların (WHI) sonuçları HT’nin koruma sağlamadığını ve hatta KVH riskini artırdığını gösterdi. Ancak WHI çalışması tekrar analiz edildiğinde; menopozdan sonra geçen sürenin 10 yıldan fazla olması halinde, KVH risk faktörü veya bilinen KVH varlığında HT kullanımının KVH riskini artırdığını, buna karşın 50-59 yaş arası ve menopozdan sonra geçen sürenin 10 yıldan az olduğu durumlarda ise hormon tedavisinin KVH riskini azalttığı görüldü. Erken postmenopozal dönemde, düşük dozda, uygun ilaçlar ile HT kullanımının kardiyovasküler yarar getireceği düşünülmektedir.

Does postmenopausal hormone therapy decrease the risk of cardiovascular disease?

Cardiovascular diseases (CVDs) are primary cause of death both in men and women. In reproductive phase women have 2.5-4.5 times less risk than men, but after the age 50 in menopause, risk gradually increases and reaches the men’s rate. Women with premature menopause have greater risk of CVDs than normal. 46% of the cause of death of middle aged women is CVDs. The lack of ovarian hormones have the key role in the increase of incidence of CVDs in postmenopausal women. While observational studies showed CVD protection with postmenopausal hormone treatment, randomized studies Women’s Health Initiative (WHI) showed increase in CVDs. Reanalysis of WHI study represented some facts; starting hormone therapy 10 years after menopause, patients with CVDs risk factors or preexisting CVD have more risk in hormone therapy, but patients with the ages between 50-59 years and patients whose years is less than 10 years since menopause have a decrease in CVDs risk. It is now clear that in early postmenopausal period low dose HT brings out cardiovascular benefits.

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