Author/Editor		Žegura, Branka
Title		Različne oblike hormonskega nadomestnega zdravljenja po menopavzi in dejavniki tveganja za aterosklerozo
Type		monografija
Place		Ljubljana
Publisher		Medicinska fakulteta
Publication year		2007
Volume		str. 103
Language		eng
Abstract		Coronary heart disease (CHD), caused by the process of atherosclerosis, is the leading cause of morbidity and death of postmenopausal women in the developed world. One of the possible reasons is the decreased level in estrogen after menopause. The underlying protective mechanisms estrogens are thought to involve both effects on cardiovascular risk factors and direct effects on the arterial vessel wall. The conclusions of observational epidemiological studies are not in accordance with those from randomised trials, where an increase in CHD risk with hormone replacement therapy (HRT) was observed. The role of HRT in primary prevention of CHD remains unclear. The type of estrogen, progestin, other routes of delivery, and different population of treated postmenopausal women may influence the risk-benefit profile with HRT. The aim of our studies was to compare the influence of different types of HRT formulations on functional and morphological changes of the arterial wall, on markers of coagulation, fibrinolysis and inflammation in healthy postmenopausal women. In the first two studies we compared the effects of both oral and transdermal estradiol (E2) on functional characteristics of arterial wall, on markers of coagulation, fibrinolysis, and inflammation and on lipids and lipoproteins in 43 healthy women after surgical menopause. The aim of the third study was to compare the effects of oral E2, with or without norethisterone acetate (NETA), and trandermal E2 on markers of hemostasis and inflammation in 112 healthy postmenopausal women. The aim of the fourth study was to assess whether the same factors are involved in early functional changes in the arterial wall, measured as endothelium-dependent dilation of the brachial artery and in morphological atherosclerotic changes, measured as carotid intima-media thickness in the population of women of women that already participated in the first two studies. (Abstact truncated at 2000 characters)
Summary		Srčno-žilne bolezni, ki jih povzroča ateroskleroza, so v razvitem svetu najbolj pomemben vzrok obolevnosti in umrljivosti žensk po menopavzi. V tem obdobju je za to eden od možnih vzrokov pomanjkanje estrogena, ki ima številne ugodne varovalne učinke na proces ateroskleroze: zaščitno vpliva na arterijsko steno in na nekatere srčno-žilne dejavnike tveganja. Čeprav so nedavne velike kontrolirane klinične študije pokazale, da hormonsko nadomestno zdravljenje (HNZ) po menopavzi ne ščiti pred srčno-žilnimi zapleti in da jih lahko celo povečuje, pa ostaja še veliko nerešenih vprašanj o vlogi HNZ pri preprečevanju srčno-žilnih bolezni. Vrsta estrogena, gestagena, način nadomeščanja estrogenov in drugačna populacija žensk po menopavzi, lahko vpliva na razmerje med tveganjem in koristijo ob HNZ. Z našimi raziskavami smo želeli preveriti hipotezo, da se pri zdravih ženskah po kirurški ali naravni menopavzi učinki HNZ na žilno steno, lipide, vnetne, koagulacijske in na fibrinolitične dejavnike tveganja razlikujejo glede na različne načine nadomeščanja in pri različni sestavi HNZ. V prvih dveh raziskavah smo pri 43 zdravih ženskah po kirurški menopavzi primerjali vpliv peroralnega in transdermalnega nadomeščanja estradiola na funkcijske lastnosti arterijske žilne stene, krvne lipide in lipoproteine, koagulacijo in fibrinolizo ter na pokazatelje vnetja. V tretji raziskavi smo proučevali tri oblike HNZ in vpliv dodanega gestagena v obliki noretisteron acetata (NETA) na hemostazo in pokazatelje vnetja pri 112 zdravih ženskah po menopavzi. V četrti raziskavi smo pri preiskovankah iz prvih dveh raziskav proučevali povezanost različnih aterogenih dejavnikov z zgodnjimi funkcijskimi in morfološkimi aterosklerotičnimi spremembami arterijske stene. (Izvl. skrajšan na 2000 zn.)
Descriptors		CARDIOVASCULAR DISEASES ATHEROSCLEROSIS MENOPAUSE MENOPAUSE ESTROGENS ESTROGEN REPLACEMENT THERAPY RISK FACTORS PROSPECTIVE STUDIES COHORT STUDIES