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Geburtshilfe Frauenheilkd 2001; 61(1): 2-7
DOI: 10.1055/s-2001-10466
Übersicht

Georg Thieme Verlag Stuttgart · New York

Hormonsubstitution im Klimakterium und zerebrovaskuläre Erkrankungen

Postmenopausal Hormone Replacement Therapy and Cerebrovascular DiseasesT. Römer1 , Dolores Foth1 , B. Griewing2
  • 1 Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe der Universität zu Köln
  • 2 Neurologische Klinik GmbH Bad Neustadt/Saale
Further Information

Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung

In epidemiologischen und tierexperimentellen Studien wurde der Nachweis erbracht, dass eine postmenopausale Hormonsubstitution das Schlaganfallrisiko senkt. Durch Blutflussuntersuchungen mittels Doppler konnte gezeigt werden, dass Estrogene einen positiven Effekt auf das zerebrovaskuläre Gefäßsystem haben, wobei dieser Effekt durch Gestagene kaum modifiziert wird. Auch morphometrische Untersuchungen, wie ultrasonographisch gestützte Messungen der Intima-Media-Dicke, belegen den positiven Einfluss einer Langzeit-Hormonsubstitution auf das zerebrovaskuläre System. Die Intima-Media-Dicke, die als ein Ausdruck der komplexen Arteriosklerose betrachtet werden kann, nimmt unter Hormonsubstitution ab. Arteriosklerotische Plaques der extrakraniellen zerebrovaskulären Gefäße sind bei Patientinnen, die hormonsubstituiert werden, signifikant seltener zu finden als in einer Vergleichsgruppe gleichaltriger Patientinnen ohne Hormonsubstitution. In einer Studie konnte sogar eine Reduktion dieser Plaques durch eine Estrogensubstitution nachgewiesen werden. Eine Hormonsubstitution kann möglicherweise einen präventiven Effekt hinsichtlich der Entstehung und Ausbreitung der zerebrovaskulären Arteriosklerose haben. Bei Zustand nach Schlaganfall ist derzeit die Indikation zur Hormonsubstitution eher strenger zu stellen, insbesondere bei Vorliegen anderer Risikofaktoren. Aktuell verfügbare Studien und eigene Ergebnisse werden dargestellt und diskutiert.

Summary

Epidemiologic and animal studies have provided evidence that hormone replacement therapy can reduce the risk of stroke. Doppler ultrasound measurements of blood flow show a positive effect of estrogens on the cardiovascular system, which is only slightly modified by progestins. Ultrasound measurements of intima-media thickness showed a positive influence of long-term hormone replacement therapy on the cerebral vasculature. The intima-media thickness, a marker of complex atherosclerosis decreases with hormone replacement therapy. The number of atherosclerotic plaques in extracranial cerebral vessels is significantly lower in patients receiving hormone replacement than in controls. One study suggested that estrogen replacement can lead to regression of atherosclerotic plaques. Hormone replacement therapy may reduce the risk for developing and progression of cerebrovascular atherosclerosis. In patients with a history of stroke the possible benefits of hormone replacement have to be weighed against risks, particularly in patients with other risk factors. We review our results and the literature.

Schlüsselwörter

Hormonsubstitution - Schlaganfall - Plaques - Intima-Media-Dicke

Key words

Hormone replacement therapy - Stroke - Plaques - Intima-media-thickness

Literatur

  • 1 Akkad A, Hartsthorne T, Bell P R, AL-Azzawi F. Carotid plaque regression on oestrogen replacement: a pilot study.  Eur J Vasc Endovasc Surg. 1996;  11 347-348
    PubMedGoogle Scholar
  • 2 Arzneimittelkommission der deutschen Ärzteschaft . Handlungsleitlinie - Primär- und Sekundärprävention des ischämischen Insults.  Z ärztl Fortbild Qualsich. 2000;  94 407-410
    PubMedGoogle Scholar
  • 3 Baron Y M, Galea R, Brincat M. Carotid artery wall changes in estrogen-treated and -untreated postmenopausal women.  Obstet Gynecol. 1998;  91 982-986
    CrossrefPubMedGoogle Scholar
  • 4 Belfort M A, Saade G R, Snabes M, Dunn R, Moise K J, Cruz A, Young R. Hormonal status affects the reactivity of the cerebral vasculature.  Am J Obstet Gynecol. 1995;  172 1273-1278
    CrossrefPubMedGoogle Scholar
  • 5 Berlit P. Schlaganfall. Möglichkeiten der Primärprävention.  Nervenarzt. 2000;  71 231-236
    CrossrefPubMedGoogle Scholar
  • 6 Bots M L, Hofman A, De Jong P T, Grobbee D E. Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid artery.  The Rotterdam Study Ann Epidemiol. 1996;  6 147-153
    PubMedGoogle Scholar
  • 7 Bush T L, Barrett-Connor E, Cowan L D. et al . Cardiovascular mortality and non-contraceptive use of estrogen in women: results from the Lipid Research Clinics Programm Follow-up Study.  Circulation. 1987;  75 1102-1109
    PubMedGoogle Scholar
  • 8 Clarkson T B, Anthony M S, Klein K P. Effects of estrogen treatment on arterial wall structure and function.  Drugs. 1994;  47 (Suppl 2) 42-51
    PubMedGoogle Scholar
  • 9 Espeland M A, Applegate W, Furberg C D, Lefkowitz D. et al . Estrogen replacement therapy and progression of intimal-medial thickness in the carotid arteries of postmenopausal women. ACAPS Investigators. Asymptomatic Carotid Atherosclerosis Progression Study.  Am J Epidemiol. 1995;  15 1011-1019
    PubMedGoogle Scholar
  • 10 Falkeborn M, Persson I, Terent A, Adami H O, Lithell H, Bergstrom R. Hormone replacement therapy and the risk of stroke. Follow-up of a population-based cohort in Sweden.  Arch Intern Med. 1993;  153 1201-1209
    CrossrefPubMedGoogle Scholar
  • 11 Finucane F F, Madans J H, Bush T L, Wolf P H, Kleinman J C. Decreased risk of stroke among postmenopausal hormone users. Results from a national cohort.  Arch Intern Med. 1993;  153 73-79
    CrossrefPubMedGoogle Scholar
  • 12 Fung M M, Barrett-Connor E, Bettencourt P R. Hormone replacement therapy and stroke risk in older women.  J Womens Health. 1999;  8 359-364
    PubMedGoogle Scholar
  • 13 Gangar K F, Vyas S, Whitehead M I. et al . Pulsatility index in the internal carotid artery is influenced by transdermal oestradiol and time since menopause.  Lancet. 1991;  338 839-842
    CrossrefPubMedGoogle Scholar
  • 14 Griewing B, Schminke U, Morgenstern C, Walker M L, Kessler C. Three dimensional ultrasound angiography (power-mode) for the quantification of carotid artery atherosclerosis.  J Neuroimag. 1997;  7 40-45
    PubMedGoogle Scholar
  • 15 Griewing B, Römer Th, Spitzer C, Günter A, Kessler C. Effects of hormone replacement therapy on carotid atherosclerosis in post-menopausal women.  Maturitas. 1999;  32 33-40
    CrossrefPubMedGoogle Scholar
  • 16 Grodstein F, Stampfer M J, Falkeborn M, Naessen T, Persson I. Postmenopausal hormone therapy and risk of cardiovascular disease and hip fracture in a cohort of Swedish women.  Epidemiology. 1999;  10 476-480
    PubMedGoogle Scholar
  • 17 Henderson B E, Paganini-Hill A, Ross R K. Decreased mortality in users of estrogen replacement therapy.  Arch Intern Med. 1991;  151 75-78
    CrossrefPubMedGoogle Scholar
  • 18 Howard G, Burke G L, Evans G W, Crouse J R, Riley W, Arnett D, de Lacy R, Heiss G. Relations of intimal medial thickness among sites within the carotid artery as evaluated by B-mode ultrasound.  Stroke. 1994;  8 1581-1587
    PubMedGoogle Scholar
  • 19 Hunskaar S, Backe B. Attitudes towards and level of information on perimenopausal and postmenopausal hormone replacement therapy among Norwegian women.  Maturitas. 1992;  15 183-194
    CrossrefPubMedGoogle Scholar
  • 20 Hunt K, Vessey M, McPherson K. Mortality in a cohort of long-term users of hormone replacement therapy: an updated analysis.  Br J Obstet Gynaecol. 1990;  97 1080-1086
    PubMedGoogle Scholar
  • 21 Hulley S, Grady D, Bush T, Furberg C, Herrington D, Biggs B, Vittinghoff E. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women.  J Am Med Ass. 1998;  280 605-613
    CrossrefPubMedGoogle Scholar
  • 22 Jonas H A, Kronmal R A, Psaty B M, Mandio T A. et al . Current estrogen-progestin and estrogen replacement therapy in elderly women: Association with carotid atherosclerosis.  Ann Epidemiol. 1996;  6 314-323
    CrossrefPubMedGoogle Scholar
  • 23 Kessler Ch, Griewing B, Morgenstern C. Epidemiologie und Inzidenz von Hirngefäßerkrankungen bei Frauen. Römer T, Straube W Klimakterium und Hormonsubstitution. Nürnberg; Klaus Pia Verlag 1996: 145-147
    Google Scholar
  • 24 Lip G, Beevers M, Churchill D, Beevers D G. Do clinicians prescribe HRT for hypertensive postmenopausal women?.  Br J Clin Pract. 1995;  49 61-64
    PubMedGoogle Scholar
  • 25 Manson J E. Postmenopausal hormone therapy and atherosclerotic disease.  Am Heart J. 1994;  128 1337-1343
    CrossrefPubMedGoogle Scholar
  • 26 Mück A O, Seeger H, Lippert T H. Biochemische Marker für Gefäßwirkungen unter Hormonsubstitution. Römer T, Straube W Klimakterium und Hormonsubstitution. Nürnberg; Klaus Pia Verlag 1996: 101-108
    Google Scholar
  • 27 Paganini-Hill A, Ross R K, Henderson B E. Postmenopausal oestrogen treatment and stroke: a prospective study.  Br Med J. 1988;  297 519-522
    PubMedGoogle Scholar
  • 28 Pedersen A T, Lidegaard O, Kreiner S, Ottesen B. Hormone replacement therapy and risk of non-fatal stroke.  Lancet. 1997;  350 1277-1283
    CrossrefPubMedGoogle Scholar
  • 29 Penotti M, Nencioni T, Gabrielli L, Farina H, Castiglioni E, Polvani F. Blood flow variations in internal carotid and middle cerebral arteries induced by postmenopausal hormone replacement therapy.  Am J Obstet Gynecol. 1993;  169 1226-1232
    PubMedGoogle Scholar
  • 30 Petitti D B, Sidney S, Quesenberry C P, Bernstein A. Ischemic stroke and use of estrogen and estrogen/progestogen as hormone replacement therapy.  Stroke. 1998;  29 23-28
    PubMedGoogle Scholar
  • 31 Pines A, Fisman E Z, Ayalon D, Drory Y. et al . Long term effects of hormone replacement therapy on Doppler-derived parameters of aortic flow in postmenopausal women.  Chest. 1992;  102 1496-1498
    PubMedGoogle Scholar
  • 32 Polak J F, Shemanski L, O'Leary D H, Lefkowitz D, Price T R, Savage P J, Brant W E, Reid C. Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study.  Radiology. 1998;  208 649-654
    CrossrefPubMedGoogle Scholar
  • 33 Punnonen R H, Jokela H A, Dastidar P S, Nevala M, Laippala P J. Combined oestrogen-progestin replacement therapy prevents atherosclerosis in postmenopausal women.  Maturitas. 1995;  21 179-187
    CrossrefPubMedGoogle Scholar
  • 34 Samsioe G. Is HRT indicated for the prevention of cardiovascular disease?.  Int J Fertil Menopausal Stud. 1995;  40 (Suppl 1) 33-39
    PubMedGoogle Scholar
  • 35 Schairer C, Adami H O, Hoover R, Persson I. Cause specific mortality in women receiving hormone replacement therapy.  Epidemiology. 1997;  8 59-65
    PubMedGoogle Scholar
  • 36 Stampfer M J, Colditz G A, Willett G C, Manson J E, Rosner B, Speizer F E, Hennekens C H. Postmenopausal estrogen therapy and cardiovascular disease. Ten year follow-up from the Nurses Health Study.  N Engl J Med. 1991;  88 1995-2002
    PubMedGoogle Scholar
  • 37 Tells G S, Plak J F, Ward B J, Kittner S J, Savage P J, Robbins J. Relation of smoking with carotid artery wall thickness and stenosis in older adults. The Cardiovascular Health Study (CHS). Collaborative Research Group.  Circulation. 1994;  90 2905-2908
    PubMedGoogle Scholar
  • 38 Thompson S G, Meade T W, Greenberg G. The use of hormonal replacement therapy and the risk of stroke and myocardial infarction in women.  J Epidemiol Community Health. 1989;  43 173-178
    PubMedGoogle Scholar
  • 39 Wilson P W, Garrison R J, Castelli W P. Postmenopausal estrogen use cigarette smoking, and cardiovascular morbidity in women over 50: the Framingham Study.  N Engl J Med. 1985;  313 1038-1043
    CrossrefPubMedGoogle Scholar

Prof. T. Römer

Klinik für Frauenheilkunde und GeburtshilfeUniversität Köln

Kerpener Straße 34

50931 Köln

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