Enfermedad cardiovascular terapia hormonal en reemplazo: estado actual de la controversia
DOI:
https://doi.org/10.31053/1853.0605.v62.n2.27919Palabras clave:
.Resumen
Los efectos cardiovasculares de los esteroides sexuales en la mujer son complejos y para complicar aún más la situación existen diferencias en los efectos de los distintos regímenes terapéuticos, dosis y vías de administración de la terapia hormonal de reemplazo (THR) en la post-menopausia. Incluso la interpretación de los estudios clínicos es problemática en vista de múltiples factores que pueden llevar a confusión, además de los sesgos y defectos metodológicos encontrados en algunas circunstancias post-hoc. En este contexto plantear conclusiones definitivas y recomendaciones parecería una tarea imposible. Nuestra sugerencia para la práctica clínica diaria es intentar seguir la corriente principal de la información científica, analizar los datos generales e intentar individualizar la THR para maximizar los beneficios y minimizar los efectos adversos. Este artículo resume el estado actual de la THR y el sistema cardiovascular. Dado lo vasto de la información en la era postWHl, solo presentamos las ideas actuales y tendencias en este campo para el uso práctico del profesional en sus decisiones clínicas.
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Hatky M, Boothroyd D, Vittinghoff E et al. Quality of life and depressive symptoms in postmenopausal women after receiving hormone therapy. Results from the HERS trial. JAMA 2002; 287(5): 591- 597.
Utian WH, Shoupe D, Bachmann G, Pinkerton JV, Pickar JH. Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and
Medroxyprogesterone acetate. Fertil Steril 2001:75:1065-1079.
The Writing Group for the PEPI trial. Effects of hormone therapy on boiie mineral density: results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial. JAMA 1996;
276:1389-1396.
Writing Group for the Women's Health Initiative lnvestigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002:288:321-333.
Wittemen J, Grobhee D, Kok E et al. Increased risk of atherosclerosis in women after menopause. Br Med J 1989:298:642-4,
Castelli WP Cardiovascular disease in women. Am J Obstet Gynecol 1988; 158: 1553.
Siseles N, Gutiérrez Fi Sayegh E The Climacteric jo Latin America: actual state and future trends. In: The Meriopause al ¿he Millenium Ed. Takeshi Aso, The Parthenon Publishing Group, 2000; 108- 116.
Barrett-Connor E. Sex differences in coronary heart disease. Why are women so superior?. The 1995 Ancel Keys Lecture. Circulation 1997;95:252-264.
Barrett-Connor E, Gracly D. Hormone replacement therapy, heart disease, and other considerations. Annu Rey Public Health 1998:19:55-72
Clarkson TB, Cune JFIM, Williams JK et al. Gonadal hormone substitutes: effects on the cardiovascular system. Osteop mt. 1997; 7(Suppl 1): S43-S5 1.
Barrett-Connor E, Bush TL. Estrogcn and coronary heart disease in womenJAMA 1991:265:1861-1867.
Bush T. Evidence for prinlary and secondary prevention of coronary artery disease in women taking oestrogen replacement therapy. Eur Heart J 1996: 17(suppl D): 9-14.
Bush T, Barret-Connor E, Cowan L et al. Cardiovascular mortality and
noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 1987; 75: 1102-1109.
Grodstein F, Stanipfer M, Colditz G et al. Postmenopausal hormone therapy and mortality. NEJM 1997; 336: 1769-1775.
Henderson B, Paganini-Hili A, Ross R. Decreased mortality in users of estrogen replacement therapy. Arch Intern Med 1991; 151: 75-78.
The Postmenopausal Estrogen! Progestin Interventions (PEPI) Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. JAMA 1995; 273:199-08..
Siseles N, Berg G, Gutiérrez P, Lerman J, Lipszyc F PralTiparo P Wikinski R. Recomendaciones para reducir el riesgo cardiovascular en la mujer climatérica. En: Recomendaciones en Climaterio, Ed. AAPEC (Asociación Argentina Para el Estudio del Climaterio) 2000; 91-100.
Mijatovic y, van der Mooren M, Stehouwer A, et al. Postmenopausal hormone replacement, risk estimators for coronary artery disease and cardiovascular protection. Gynecol Endocrinol 1999; 13: 130-144.
Hulley S. Grady D, Bush T et al, for the HERS Research Group. Randoinized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women: Heart and Estrogen/progestin Replacement Study (HERS) Research Group, JAMA 1998; 280: 605-613.
Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Womens Health Initiative Randomized Controlled Tríal. JAMA 2004; 291 (14): 1701- 1712.
Naftolin F et al. The Womens Health Initiative could not have detected cardioprotective effects of starting hormone therapy during the menopause transition. Fertil SIen! 2004; 81(6): 1498-1501
Studd J. Second thoughts on the Women 's Health Initiative study: the effects of age on the safety of HRT. Persona! view. C!imacteric 2004; 7: 412-414.
Naftolin F, Schneider H, Sturdee D for The Writlng Group of the IMS Executive Committee, with contributions from the other members of the Executive Committee: M. Birkh.user, M.P Brincat, M. Gambacciani, A.R. Genazzani (Ex officio), K.K. Limpaphayorn, S. O'Ncill, S. Palacios, A. Pines, N. Siseles, D. Tan, and H. G. Burger (Ex offlcio). Guidelines for hormone treatment of the women in the menopause transition and beyond. IMS revised Position Statement. Climactenic 2004; 7: 333-337.
Maas a, van der Schovw Y, Grobbe D et al. Rise and fali of hormone therapy in postmenopause women with cardiovascular disease. Menopause 2004;11(2): 228-235.
Adami S, Rossini M, Zamberlan N, et al. Long-term effects of transdermal and oral estrogens on serum !ipids and lipoprotcins in postmenopausal women. Maturitas 1993; 17:191-196.
Siseles N, Berg G, Gutiérrez P Moggia S, Prada M. Hormone replacement therapy and lipid profile: effects of differents routes of administration. !n: Proceedings of t he 8' World Congress of Gynecological Endocrinology. Florence, Italy, deceniber 6-9, 2000. Advances in Gyriecological Endocninology. Ed. A. Genazzani and E. Petraglia 237-243, 2001.
Taskin O et al. HRT and Tibo!one improve systolic and diastolic phases in postmenopausal Women. Maturitas 2004; 48: 354-359.
Curtis M. Selective estrogen receptor modulators: a controvertial approach for managing postmenopausal health. J Womens Health 1999; 8: 321- 323.
Siseles N, Campodonico 1, Gutiérrez P, Belardo A. Consenso Latinoamericano sobre THR Postmenopáusica. En Actas del IV Congreso Latinoamericano de Climaterio y Menopausia, FLASCYM 31 octubre al 4 noviembre 2004, 20.
Hatky M, Boothroyd D, Vittinghoff E et al. Quality of life and depressive symptoms in postmenopausal women after receiving hormone therapy. Results from the HERS trial. JAMA 2002; 287(5): 591- 597.
Utian WH, Shoupe D, Bachmann G, Pinkerton JV, Pickar JH. Relief of vasomotor symptoms and vaginal atrophy with lower doses of conjugated equine estrogens and
Medroxyprogesterone acetate. Fertil Steril 2001:75:1065-1079.
The Writing Group for the PEPI trial. Effects of hormone therapy on boiie mineral density: results from the Postmenopausal Estrogen/Progestin Interventions (PEPI) trial. JAMA 1996;
276:1389-1396.
Writing Group for the Women's Health Initiative lnvestigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002:288:321-333.
Wittemen J, Grobhee D, Kok E et al. Increased risk of atherosclerosis in women after menopause. Br Med J 1989:298:642-4,
Castelli WP Cardiovascular disease in women. Am J Obstet Gynecol 1988; 158: 1553.
Siseles N, Gutiérrez Fi Sayegh E The Climacteric jo Latin America: actual state and future trends. In: The Meriopause al ¿he Millenium Ed. Takeshi Aso, The Parthenon Publishing Group, 2000; 108- 116.
Barrett-Connor E. Sex differences in coronary heart disease. Why are women so superior?. The 1995 Ancel Keys Lecture. Circulation 1997;95:252-264.
Barrett-Connor E, Gracly D. Hormone replacement therapy, heart disease, and other considerations. Annu Rey Public Health 1998:19:55-72
Clarkson TB, Cune JFIM, Williams JK et al. Gonadal hormone substitutes: effects on the cardiovascular system. Osteop mt. 1997; 7(Suppl 1): S43-S5 1.
Barrett-Connor E, Bush TL. Estrogcn and coronary heart disease in womenJAMA 1991:265:1861-1867.
Bush T. Evidence for prinlary and secondary prevention of coronary artery disease in women taking oestrogen replacement therapy. Eur Heart J 1996: 17(suppl D): 9-14.
Bush T, Barret-Connor E, Cowan L et al. Cardiovascular mortality and
noncontraceptive use of estrogen in women: results from the Lipid Research Clinics Program Follow-up Study. Circulation 1987; 75: 1102-1109.
Grodstein F, Stanipfer M, Colditz G et al. Postmenopausal hormone therapy and mortality. NEJM 1997; 336: 1769-1775.
Henderson B, Paganini-Hili A, Ross R. Decreased mortality in users of estrogen replacement therapy. Arch Intern Med 1991; 151: 75-78.
The Postmenopausal Estrogen! Progestin Interventions (PEPI) Trial. Effects of estrogen or estrogen/progestin regimens on heart disease risk factors in postmenopausal women. JAMA 1995; 273:199-08..
Siseles N, Berg G, Gutiérrez P, Lerman J, Lipszyc F PralTiparo P Wikinski R. Recomendaciones para reducir el riesgo cardiovascular en la mujer climatérica. En: Recomendaciones en Climaterio, Ed. AAPEC (Asociación Argentina Para el Estudio del Climaterio) 2000; 91-100.
Mijatovic y, van der Mooren M, Stehouwer A, et al. Postmenopausal hormone replacement, risk estimators for coronary artery disease and cardiovascular protection. Gynecol Endocrinol 1999; 13: 130-144.
Hulley S. Grady D, Bush T et al, for the HERS Research Group. Randoinized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women: Heart and Estrogen/progestin Replacement Study (HERS) Research Group, JAMA 1998; 280: 605-613.
Effects of conjugated equine estrogen in postmenopausal women with hysterectomy. The Womens Health Initiative Randomized Controlled Tríal. JAMA 2004; 291 (14): 1701- 1712.
Naftolin F et al. The Womens Health Initiative could not have detected cardioprotective effects of starting hormone therapy during the menopause transition. Fertil SIen! 2004; 81(6): 1498-1501
Studd J. Second thoughts on the Women 's Health Initiative study: the effects of age on the safety of HRT. Persona! view. C!imacteric 2004; 7: 412-414.
Naftolin F, Schneider H, Sturdee D for The Writlng Group of the IMS Executive Committee, with contributions from the other members of the Executive Committee: M. Birkh.user, M.P Brincat, M. Gambacciani, A.R. Genazzani (Ex officio), K.K. Limpaphayorn, S. O'Ncill, S. Palacios, A. Pines, N. Siseles, D. Tan, and H. G. Burger (Ex offlcio). Guidelines for hormone treatment of the women in the menopause transition and beyond. IMS revised Position Statement. Climactenic 2004; 7: 333-337.
Maas a, van der Schovw Y, Grobbe D et al. Rise and fali of hormone therapy in postmenopause women with cardiovascular disease. Menopause 2004;11(2): 228-235.
Adami S, Rossini M, Zamberlan N, et al. Long-term effects of transdermal and oral estrogens on serum !ipids and lipoprotcins in postmenopausal women. Maturitas 1993; 17:191-196.
Siseles N, Berg G, Gutiérrez P Moggia S, Prada M. Hormone replacement therapy and lipid profile: effects of differents routes of administration. !n: Proceedings of t he 8' World Congress of Gynecological Endocrinology. Florence, Italy, deceniber 6-9, 2000. Advances in Gyriecological Endocninology. Ed. A. Genazzani and E. Petraglia 237-243, 2001.
Taskin O et al. HRT and Tibo!one improve systolic and diastolic phases in postmenopausal Women. Maturitas 2004; 48: 354-359.
Curtis M. Selective estrogen receptor modulators: a controvertial approach for managing postmenopausal health. J Womens Health 1999; 8: 321- 323.
Siseles N, Campodonico 1, Gutiérrez P, Belardo A. Consenso Latinoamericano sobre THR Postmenopáusica. En Actas del IV Congreso Latinoamericano de Climaterio y Menopausia, FLASCYM 31 octubre al 4 noviembre 2004, 20.
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2021-03-25
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Siseles N, Gutiérrez P. Enfermedad cardiovascular terapia hormonal en reemplazo: estado actual de la controversia. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 25 de marzo de 2021 [citado 2 de mayo de 2024];62(2):67-71. Disponible en: https://revistas.unc.edu.ar/index.php/med/article/view/27919
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