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Hormonersatztherapie und kardiovaskuläre Erkrankungen

Hormone replacement therapy and cardiovascular diseases

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Zusammenfassung

Frauen vor der Menopause sind seltener von kardiovaskulären Ereignissen betroffen als Männer. Die Unterschiede gehen aber nach der Menopause zunehmend verloren. In epidemiologischen Untersuchungen geht die Östrogenbehandlung typischer Postmenopausenbeschwerden mit günstigen Effekten auf die koronare Herzkrankheit (KHK) einher. Die Überprüfung in prospektiven, randomisierten Interventionsstudien ergibt jedoch keinen Hinweis auf Protektion gegenüber kardiovaskulären Ereignissen durch eine langfristige Östrogentherapie. Stattdessen nimmt das Risiko für KHK in Abhängigkeit vom Beginn der Therapie nach der Menopause sogar zu wie auch das Risiko für Schlaganfall und Lungenembolien. Für Phytoöstrogene oder synthetische Steroide mit Östrogenwirkung (z. B. Tibolon) sind keine präventiven Effekte nachgewiesen. Auch Raloxifen, ein selektiver Östrogenrezeptormodulator (SERM), lässt keinen protektiven Effekt auf das KHK-Risiko erkennen. Eine Hormonersatztherapie (HET) zur Prophylaxe kardiovaskulärer Ereignisse kann deshalb nicht empfohlen werden. Wegen des erhöhten Mammakarzinomrisikos sollten Hormone in der Postmenopause nur zur Behandlung schwerer Menopausensymptome eingesetzt werden.

Abstract

Women enjoy a lower incidence of cardiovascular events than men, but this advantage is lost during the postmenopause. Epidemiological studies suggested that estrogen therapy for postmenopausal symptoms may exert protective effects against coronary heart disease (CHD); however, prospective, randomized clinical studies do not confirm cardiovascular protective effects of long-term treatment with estrogen/gestagen combinations. Instead, the risks for CHD, stroke, pulmonary embolism, and breast cancer increased, whereas the risks for hip fracture and colon carcinoma decreased. Phytoestrogens and synthetic steroids with estrogen action have not been shown to protect against cardiovascular disease, and raloxifene, a selective estrogen receptor modulator (SERM), has not demonstrated protection against CHD. Hormone replacement therapy in the postmenopause therefore cannot be recommended for cardiovascular risk reduction, but should only be initiated for severe postmenopausal symptoms.

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  1. Institut für Pharmakologie und Toxikologie, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland

    U. Ravens

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Ravens, U. Hormonersatztherapie und kardiovaskuläre Erkrankungen. Kardiologe 2, 435–448 (2008). https://doi.org/10.1007/s12181-008-0114-9

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