Seval Atabey HAKTANKAÇMAZ, Özlem Gün ERYILMAZ, Banu USLU AKÇAL, Aylin Aker AYRIM

Postmenopozal hormone replasman tedavisinin anjiotensinojen dönüştürücü enzim seviyeleri üzerine etkisi

Giriş: Postmenopozal dönemde, artan anjiotensinojen dönüştürücü enzim (ACE) seviyeleri, kardiovasküler hastalık risklerinin artışı ile ilişkilendirilmiştir. Hormon replasman tedavisi (HRT) ile bu enzim aktivitesinin azaldığı, böylece kardioprotektif bir etki göstereceği belirtilmiştir. Materyal ve Metot: Prospektif, randomize ve kontrollü bir çalışma olarak yapılan bu araştırmada, 39 hasta transdermal HRT (Grup A; 1,5 mg estradiol +100 mg mikronize progesteron) alırken, geri kalan 52 hastaya da oral HRT (Grup B; 0.625 mg konjuge ekin estrojen + 2,5 mg medroksiprogesteron asetat) verildi. Kontrol grubunu (Grup C) HRT kullanmayan 22 hasta oluşturdu. Altı aylık tedavi sürecini takiben, tüm gruplar, kolesterol, trigliserid, düşük yoğunluklu lipoprotein kolesterol, çok düşük yoğunluklu lipoprotein kolesterol, yüksek yoğunluklu lipoprotein kolesterol ve ACE düzeyleri açısından karşılaştırıldı. Bulgular: Oral HRT alan hastaların, VLDL ve ACE değerleri, kontrol hastalarına oranla anlamlı olarak düşükken, HDL değerleri de anlamlı olarak yüksek ölçüldü (sırasıyla p=0,04; p=0,01; p=0,01). Transdermal HRT alan grupta, VLDL ve ACE değerleri, kontrolle karşılaştırıldığında, anlamlı olarak düşük tespit edildi (sırasıyla p=0,0001, p=0,04). Transdermal ve oral HRT alan gruplar karşılaştırıldığında, ACE değerleri açısından bir fark tespit edilmedi (p>0,05). Tartışma: Postmenopozal HRT kullanımı sonrası azalan ACE seviyeleri, hipertansif hastalarda, kardiovasküler hastalık risklerine karşı sekonder koruyucu etki gösterebilir. Normotansif hastalarda da, bu etki, primer koruyuculuk yönünde gelişebilir.

Effect of postmenopausal hormone replacement therapy on the levels of angiotensinogen converting enzyme

Background: To analyze the cardioprotective effect of postmenopausal hormone replacement therapy on the levels of angiotensinogen converting enzyme (ACE). Material and Methods: In this prospective, randomised, controlled study, a total of 81 postmenopausal women were given HRT. Transdermal HRT was given to 39 patients (Group A), and another 52 patients took oral HRT (Group B). Twenty-two patients served as controls in Group C. After sixth months of treatment period all of the groups were compared with respect to serum cholesterol, low density lipoprotein, very low density lipoprotein, high density lipoprotein and ACE levels. Results: Serum VLDL and ACE levels of the oral route HRT group were significantly lower than the control group, whereas HDL levels were significantly higher (p=0.04; p=0.01; p=0.01, respectively). Serum VLDL and ACE levels of the transdermal route HRT group were also lower than the control group with significant results (p=0.0001; p=0.04, respectively). The comparison of ACE levels between the oral and the transdermal route groups was insignificant (p>0.05). Conclusions: HRT decreases the serum ACE levels in postmenopausal women. This action may have primary cardioprotective effects in normotensive women or it may secondarily prevent the cardiovascular morbidity in hypertensive women.

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