雌激素代治疗.ppt

Objectives Understand the magnitude of coronary heart disease (CHD) in postmenopausal women Explain the mechanisms behind estrogen’s proposed cardioprotective effect Review the observational data supporting the use of estrogen in preventing CHD Discuss the results of the recently completed Heart and Estrogen/progestin Replacement Study (HERS) and apply them to clinical practice Cardiovascular Disease in Women One in two women will die of cardiovascular disease (CVD) if all forms of major CVD were eliminated life expectancy would increase by 10 years One in 26 women will die of breast cancer if all forms of cancer were eliminated life expectancy would increase by 3 years Coronary Heart Disease: Despite Advances, Still the #1 Killer Percentage Breakdown of Deaths From Cardiovascular Diseases United States: 1995 Mortality, Final Data Premenopausal Postmenopausal Decrease in HDL Increase in LDL, triglycerides, apolipoproteins B and A-I Increase in diastolic blood pressure Estrogen and Lipids Decrease LDL 5-15% Increase HDL 5-15% Increase triglycerides 4-14% +/- lipoprotein (a) Effect dependent on route and formulation Estrogen’s Mechanism of Action on Lipids Induction of LDL receptor formation Destruction of hepatic lipase 25-50% of beneficial effect on CHD Platelet Effects Increased production of local prostacyclin (PGI2) enhancement of prostacyclin stabilizing factor Favorable prostacyclin/thromboxane balance increase in blood flow anti-aggregation effect Peripheral Vascular Effects Estrogen receptors in blood vessels Estrogen increases in blood flow decrease in arterial impedance decreased vascular tone in uterine arteries increase in cerebrovascular blood flow Decreased anginal episodes and increases in treadmill times Peripheral Vascular Effects Increased production of prostacyclin in endothelium Decreased thromboxane A2 synthesis by platelets Facilitate release or response to nitrous oxide Inhibit release or response to constrictor factors Calcium ch