Rủi ro bệnh tim mạch liên quan đến mãn kinh

Endocrine Connections - Tập 11 Số 4 - 2022
Panagiotis Anagnostis1, Ιrene Lambrinoudaki2, John C. Stevenson3, Dimitrios G. Goulis1
1Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
22nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Medical School, Athens, Greece
3National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK

Tóm tắt

Bệnh tim mạch (CVD) là mối quan tâm lớn đối với phụ nữ bước vào giai đoạn mãn kinh. Môi trường hormon thay đổi khiến họ có nguy cơ mắc CVD cao hơn, do một loạt các yếu tố nguy cơ như béo phì nội tạng, rối loạn lipid máu gây xơ vữa, rối loạn trong việc kiểm soát glucose, bệnh gan nhiễm mỡ không do rượu và tăng huyết áp. Tuy nhiên, mối liên hệ độc lập giữa mãn kinh per se với nguy cơ cao hơn đối với các sự kiện CVD chỉ được chứng minh cho mãn kinh sớm (<45 tuổi). Liệu pháp hormon mãn kinh (MHT) làm giảm hầu hết các yếu tố nguy cơ CVD đã đề cập. Estrogen qua da là chế độ điều trị được ưu tiên, vì chúng không làm tăng nồng độ triglyceride và không có liên quan đến nguy cơ tăng lên của các sự kiện huyết khối tĩnh mạch (VTE). Mặc dù việc sử dụng MHT nên được xem xét trên cơ sở từng cá nhân, MHT có thể làm giảm tình trạng bệnh tật và tử vong do CVD, nếu được bắt đầu trong giai đoạn đầu sau mãn kinh (<60 tuổi hoặc trong vòng mười năm kể từ kỳ kinh cuối). Đối với phụ nữ bị suy buồng trứng sớm (POI), MHT nên được áp dụng ít nhất cho đến độ tuổi trung bình của mãn kinh (50–52 tuổi). MHT chống chỉ định ở những phụ nữ có tiền sử VTE và hiện nay không được khuyến nghị chỉ nhằm mục đích ngăn ngừa CVD. Nguy cơ ung thư vú liên quan đến MHT thường là thấp và chủ yếu do progestogen gây ra. Progesterone micronized và dydrogesterone có liên quan đến nguy cơ thấp hơn so với các progestogen khác.

Từ khóa


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