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Kardiovaskuläre Risiken unter HRT in der Postmenopause

Cardiovascular risks in postmenopausal women receiving HRT

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Gynäkologische Endokrinologie Aims and scope

Zusammenfassung

Wichtigste kardiovaskuläre Risiken sind Herzinfarkte, Hirninsulte und venöse Thromboembolien – Endpunkte auch der Women’s Health Initiative (WHI), in der eine HRT mit im Mittel ca. 65-jährigen Frauen mit hohem kardiovaskulärem Risiko geprüft wurde. Unter Einbeziehung der gesamten Evidenz ist die Risikoerhöhung für venöse Thrombosen zumindest unter einer oralen HRT gesichert. Auf Basis der WHI muss auch ein erhöhtes Insultrisiko als nachgewiesen gelten, vermutlich jedoch nur für prädisponierte bzw. ältere Frauen, v. a. mit Hypertonie. Bezüglich Herzinfarkt zeigt sich das Risiko für jüngere Frauen ohne kardiovaskuläre Vorerkrankungen eher reduziert, v. a. unter Östrogenmonotherapie. Nach derzeitiger Datenlage eignet sich eine HRT jedoch nicht zur Primärprävention. In der WHI war das Infarktrisiko allerdings nur für Frauen mit Beginn einer HRT 20 Jahre nach der Menopause initial signifikant erhöht. Bei erhöhtem Risiko, speziell bei Vorliegen kardiovaskulärer Erkrankungen, muss jedoch auch für jüngere Frauen mit einer erhöhten Erkrankungswahrscheinlichkeit gerechnet werden.

Abstract

The most important cardiovascular risks are myocardial infarction, stroke, and venous thromboembolism – also end points in the Women’s Health Initiative (WHI), which studied HRT in women aged on average about 65 years at high cardiovascular risk. Taking all evidence into account, an increase in risk for venous thrombosis has been confirmed at least for oral HRT. Based on the WHI increased stroke risk should be regarded as proven, but probably only for predisposed or elderly women, especially hypertensive patients. Concerning myocardial infarction the risk is more likely to be reduced in younger women without preexisting cardiovascular conditions, especially during estrogen-only therapy. However, according to current data HRT is not recommended for primary prevention, although in the WHI trial the risk of myocardial infarction was only significantly increased in women starting HRT 20 years after menopause. However, a risk increase should also be considered in younger women at enhanced risk, especially with preexisting cardiovascular conditions.

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  1. Schwerpunkt für Endokrinologie und Menopause, Institut für Frauengesundheit BW, Universitäts-Frauenklinik Tübingen, Calwerstraße 7, 72076, Tübingen, Deutschland

    A.O. Mueck & H. Seeger

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  1. A.O. Mueck
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  2. H. Seeger
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Correspondence to A.O. Mueck.

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Mueck, A., Seeger, H. Kardiovaskuläre Risiken unter HRT in der Postmenopause. Gynäkologische Endokrinologie 5, 120–126 (2007). https://doi.org/10.1007/s10304-007-0191-z

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