For women talking to their doctors about hormone therapy to relieve menopausal symptoms, the decision is not always easy. Hormone therapy increases the risk of cardiovascular disease, but so does middle age itself. This is simply due to the aging process and increased risk factors such as high blood pressure and obesity.
Robert Wild, MD, Ph.D., and MPH, physician scientists at the University of Oklahoma School of Medicine, recently published a groundbreaking study in the journal. menopause It provides subject clarity.His study shows that determining a woman’s “vascular age” is a better indicator Risk of cardiovascular disease From her chronological age or years since menopause.
For years, doctors have usually considered the age of women and the duration of menopause to make the following decisions: hormone Treatment is low enough. However, it does not always provide the clearest answer. A 52-year-old woman who smokes, is overweight, and has high cholesterol faces a much higher cardiovascular risk than a 65-year-old woman who has few. Risk factor.. Wild’s study has shown that measuring the risk of cardiovascular disease in women, or vascular age, is a much better tool for making decisions about hormone therapy.
“What this study tells us is that we must see the true risk of cardiovascular disease, regardless of age,” Wild said. “Age does play a role, but it depends on other risk factors. We have to make individual decisions rather than using a wide range of brush strokes.”
Wild, the lead author of the publication, studied data from the Women’s Health Initiative, a long-term research project focused on preventive strategies. Heart disease Some other conditions in postmenopausal women. In the world’s largest hormone therapy trial, 27,347 postmenopausal women aged 50 to 79 years were enrolled nationwide between 1993 and 1998. Some received hormone therapy, while others received placebo. A large amount of data on women’s overall health was collected at enrollment, and the trials continued to analyze for nearly 18 years, providing a treasure trove of information on which women had cardiovascular disease.
To examine that data, Wild used two different cardiovascular risk scoring systems. One is from the American College of Cardiology and the American College of Cardiology, and the other is called the Flamingam Risk Score. The two scoring systems are similar in that they assess vital signs such as age, race, total cholesterol, HDL (the “good” part of cholesterol), systolic blood pressure, blood pressure drug use, diabetes, and smoking status. I have. Framingham scores are different because they use Body Mass Index (BMI) instead of HDL cholesterol.
At the end of the study, evidence was clear: both cardiovascular risk scoring systems were better predictors of cardiovascular disease than chronological age and years since menopause.
“This is a groundbreaking study, because it’s the opposite of the general debate so far,” Wild said. “This is the culmination of many years of work, and we are pleased to hear that it is now open to the public. It is for patient management as it can begin quantifying risk and improve risk beyond the simple ones. Important. Age estimate. “
Over the years, hormone therapy has led to a polarization between the medical disciplines. Cardiologists tend to oppose hormone therapy, while gynecologists and primary care physicians tend to prescribe hormone therapy to relieve the patient’s symptoms. However, Wild’s research does provide a midpoint and enhanced method for predicting risk. He said he hopes this approach will soon become part of clinical practice. He said risk scoring systems are easy to use and many healthcare systems integrate them into electronic health records.
Wild also incorporates his findings as an educator of medical students and residents into his work. He is developing a clinic that gives him more experience in managing menopause, especially for those who attend primary care, obstetrics and gynecology.
Studies also need to empower patients to share the decision-making process regarding the initiation of hormones Treatment Or change the dose if you have already started.
“We need to personalize our decisions about Hormone therapy“This study verifies that it is possible because it can more accurately estimate the age of blood vessels,” Wild said.
University of Oklahoma
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Determining “vascular age” is the best predictor of cardiovascular risk from hormone therapy, the study says.
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