Información del artículo
La supresión hormonal asociada a la menopausia se asocia a un aumento del riesgo cardiovascular, principalmente relacionado con alteraciones del perfil lipídico y metabolismo hidrocarbonado. Inicialmente la terapia hormonal sustitutiva parecía asociarse a una disminución de complicaciones coronarias, si bien estudios controlados más recientes no confirman este beneficio e incluso sugieren aumentar el riesgo coronario y de otras complicaciones trombóticas, así como cáncer de mama. El raloxifeno se presenta como una alternativa al modular selectivamente los receptores estrogénicos antagonizando sus efectos deletéreos en mama y útero, potenciando sus efectos beneficiosos óseos y cardiovasculares. Los primeros datos sugieren que mejora el pronóstico en mujeres de riesgo cardiovascular alto en torno al 40%, si bien son necesarios más estudios que confirmen el posible efecto beneficioso del raloxifeno.
El Texto completo está disponible en PDF
Bibliografía
[1.]
D.J. Lerner, W.B. Kannel.
Patterns of coronary heart disease in women: Perpective from the Framingham Study.
Am Heart J, 114 (1987), pp. 413-414
[2.]
The Writing Group for the PEPI Trial:.
Effects of estrogen or estrogen/ progestin regimens on heart disease risk factors in postmenopausal women.
JAMA, 273 (1995), pp. 199-208
[3.]
H. Tunsdall-Pedoe.
Mito y paradoja del riesgo coronario y la menopausia.
The Lancet (ed esp), 351 (1998), pp. 1425-1427
[4.]
J.B. McKinlay.
Some contributions from the Social System to the Gender Inequalities in Herat Disease.
J Health Soc Behav, 37 (1996), pp. 1-26
[5.]
S. Hulley, D. Grady, T. Bus, C. Furberg, D. Herrington, B. Riggs, et al.
Randomized trial on estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group.
JAMA, 280 (1998), pp. 605-613
[6.]
R.K. Ross, A. Paganini-Hill, T.M. Mack, et al.
Menopausal estrogen therapy and protection from death from ischemic heart disease.
Lancet, i (1981), pp. 858-860
[7.]
J.M. Sullivan, R. Vander Zwaag, G.F. Lemp, et al.
Postmenpausal estrogen use and coronary atherosclerosis.
Ann Intern Med, 108 (1988), pp. 358-363
[8.]
H.W. Gruchow, A.J. Anderson, J.J. Barboriak, et al.
Postmenopausal use of estrogen and occlusion of coronary arteries.
Am Heart J, 115 (1985), pp. 954-963
[9.]
M.J. Stampfer, W.C. Willet, G.A. Colditz, et al.
A prospective study of postmenopausal estrogen therapy and coronary heart disease.
N Engl J Med, 313 (1985), pp. 1044-1049
[10.]
M. Falkeborn, I. Persson, A. Terens, et al.
Hormone replacement therapy and the risk of stroke.
Arch Intern Med, 153 (1993), pp. 1201-1209
[11.]
M.J. Stampfer, G.A. Colditz.
Estrogen replacement therapy and coronary heart disease: A quantitative assessment of the epidemiologic evidence.
Prev Med, 20 (1991), pp. 47-63
[12.]
S. Clarke, J. Kelleher, H. Lloyd-Jones, L. Sharples, M. Slack, P.M. Schofield.
Transdermal hormona replacement therapy for secondary prevention of coronary artery disease in postmenopausal women [abstract].
Eur Heart J, 21 (2000), pp. 212
[13.]
P. Angerer, S. Stork, W. Kothny, P. Schmitt, C. von Schacky.
Effect of oral postmenopausal hormona replacement on progresión of atherosclerosis: a randomized, controlled trial.
Arterioscle Thromb Vasc Biol, 21 (2001), pp. 262-268
[14.]
H.N. Hodis, W.J. Mack, R.A. Lobo, D. Shoupe, A. Sevanian, P.R. Mahrer, et al.
Estrogen in the prevention of atherosclerosis. A randomized, double-blind, placebo-controlled trial.
Ann Intern Med, 135 (2001), pp. 939-953
[15.]
D. Grady, D. Herrington, V. Bittner, R. Blumenthal, M. Davidson, M. Hlathy, et al.
Cardiovascular disease outcomes during 6.8 years of hormone therapy. Heart and Estrogen/progestin Replacement Study follow-up (HERS II).
JAMA, 288 (2002), pp. 49-57
[16.]
Writing Group for the Women's Health Initiative Investigators..
Risks and benefits of estrogen plus progestin in healthy postmenopausal women.
JAMA, 288 (2002), pp. 321-333
[17.]
J. Hippisley, M. Pringle, N. Crown, C. Coupland.
A case-control study on the effect of hormone replacement therapy on isquemic heart disease.
Br J Gen Pract, 53 (2003), pp. 191-196
[18.]
L. Mosca, P. Collins, D.M. Herrington, et al.
Hormona replacement therapy and cardiovascular disease: a statement for health professionals from the American Heart Association.
Circulation, 104 (2001), pp. 499-503
[19.]
R. Eastell, J. Adachi, K. Harper, et al.
The effects of Raloxifeno on incident vertebral fractures in Postmenopausal women with osteoporosis: 4 years results from the MORE trial.
J Bone Mineral Research, 15 (2000), pp. S229
[20.]
B. Ettinger, D.M. Black, B.H. Mitlak, et al.
Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with Raloxifeno:results from a 3 years randomised clinical trial.
JAMA, 282 (1999), pp. 637-664
[21.]
B.W. Walsh, L.H. Kuller, R.A. Wild, S. Paul, M. Farmer, J.B. Lawrence, et al.
Effects of raloxifene on serum lipids and coagulation factors in healthy postmenopausal women.
JAMA, 279 (1998), pp. 1445-1451
[22.]
E. Barrett-Connor, D. Grady, A. Sashegyi, P.W. Anderson, D.Z. Cox, K. Hoszowski, et al.
Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial.
JAMA, 287 (2002), pp. 847-857
[23.]
S. Yusuf, S. Anand.
Hormone replacement therapy: a time for pause.
CAMJ, 167 (2002), pp. 357-359
[24.]
J. Rymer, R. Wilson, K. Ballard.
Making decisions about hormone replacement therapy.
BMJ, 326 (2003), pp. 322-326
[25.]
W.C. Willet, G. Colditz, M. Stampfer.
Postmenopausal estrogensoppsed, unpposed, or none of the above.
JAMA, 283 (2000), pp. 534-535
[26.]
F.R. Pérez-López.
Tratamiento hormonal de la menopausia: controversias, precisiones y perspectivas.
Med Clin (Barc), 120 (2003), pp. 148-155
[27.]
F. Grodstein, T.B. Clarkson, J.E. Manson.
Understanding the divergent data on postmenopausal hormone therapy.
N Engl J Med, 348 (2003), pp. 645-650
[28.]
A. Day.
Lessons from the Women's Health Initiative: primary preventin and gender health.
CAMJ, 167 (2002), pp. 361-362
Copyright © 2004. Elsevier España, S.L. y Sociedad Española de Medicina Rural y Generalista (SEMERGEN)
