Cardiovascular risk assessment in women: which women are suited for menopausal hormone therapy?

Abstract

Individual risk assessment for atherosclerotic cardiovascular disease is important for safe menopausal hormone prescription. Besides the traditional risk factors, female-specific risk variables related to pregnancy and gynecologic conditions importantly contribute to a more tailored risk assessment in women at middle age. Of these, prior pre-eclampsia/HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome and early spontaneous menopause (<40 years) seem to be the strongest adverse risk variables. Concomitant inflammatory disorders should also be taken into account. Adding a coronary artery calcium score with a computed tomography scan to risk assessment has a high predictive value for future cardiovascular events. This should be considered to discriminate between low-risk and high-risk women when uncertainty exists. In women at intermediate risk, menopausal hormone therapy can be easily combined with preventive medication if cardiovascular risk factors are present. In women at higher risk who have severe disabling vasomotor symptoms, a lower dosage of hormone therapy can be considered in good collaboration between the gynecologist and the cardiologist/vascular specialist.

摘要

动脉粥样硬化性心血管疾病的个体风险评估对于安全的绝经后激素处方具有重要意义。除了传统的风险因素, 与妊娠和妇科疾病相关的女性特有的风险变量对中年女性进行更有针对性的风险评估具有重要意义。其中, 先兆子痫/HELLP（溶血、肝酶升高和血小板降低）综合征和早期自发性绝经（<40岁）似乎是最强烈的不良风险变量。伴随的炎症性疾病也应该被考虑在内。将计算机断层扫描冠状动脉钙化积分加入风险评估中, 对未来的心血管事件有很高的预测价值。当存在不确定性时, 应考虑区分低风险和高风险女性。在中等风险的女性中, 如果存在心血管危险因素, 绝经激素治疗可以很容易地与预防性药物相结合。对于有严重血管舒缩症状的高风险女性, 在妇科医生和心血管专家的良好合作下, 可以考虑使用较低剂量的激素治疗。

Keywords:

• Atherosclerotic cardiovascular disease
• coronary artery calcium score
• female-specific risk factors
• inflammatory disorders
• menopausal hormone therapy

Potential conflict of interest

The author reports the following conflicts of interest: consultancy for Organon and Omron. The author alone is responsible for the content and writing of the article.

Source of funding

None.