Abstract:
BACKGROUND:The effect of postmenopausal hormone therapy (HT) on cardiovascular disease (CVD) risk remains controversial. OBJECTIVE AND RATIONALE:We aimed to systematically review the evidence regarding the role of dose, route of hormone administration, timing of initiation and duration of HT on cardiovascular risk among postmenopausal women. SEARCH METHODS:The electronic databases Medline Ovid, Web of Science and Cochrane Central were systematically searched to identify studies published before 30 January 2018. Reference lists, using Elsevier's Scopus, of the included studies were searched for further identification of relevant studies. Clinical trials and observational studies that assessed clinical and subclinical cardiovascular outcomes in relation to dose, route of administration, duration of use, or timing of HT initiation among postmenopausal women were included. Data were extracted by independent reviewers using a pre-designed data collection form. The Cochrane Collaboration's tool and the Newcastle-Ottawa Scale were used by two independent investigators to assess the risk of bias in RCTs and in prospective observational studies, respectively. OUTCOMES:In total, 33 unique studies (6 trials and 27 prospective observational studies) were identified, including a total of 2 588 327 women. The synthesis of the existing knowledge on this topic was challenging due to inconsistent findings between some studies, caused by substantial diversity in scientific rigor and quality across the available literature. Overall, the evidence did not support the concerns that oral or transdermal HT increases heart disease risk. Contrary, observational data showed that a beneficial cardioprotective effect can be observed even with use of low doses of oral HT (effect of 0.3 mg/day of oral conjugated equine estrogen was similar to that seen with the standard dose of 0.625 mg/day), but clinical trials to support a cardioprotective benefit of HT in primary prevention have not been identified. Furthermore, the current data suggested that oral and transdermal HT, in dose-dependent manner and irrespective of HT formulation, may increase thromboembolic risk, as well as risk of stroke. However, transdermal estrogen with <50 μg/day of estrogen combined with micronized progesterone appears to be the safer choice with respect to thrombotic and stroke risk. Also, vaginal HT administration may play a role in myocardial infarction and stroke risk prevention, but this is based on limited evidence and requires further investigation. The timing of HT initiation and duration may be important factors to consider when prescribing HT especially in women with adverse cardiometabolic profile and pre-existing conditions such as coronary/carotid atherosclerosis, which are at risk of developing, and thus progressing to CVD. The quality of evidence was generally low or moderate and the findings were based mostly on observational data. WIDER IMPLICATIONS:Use of low-dose oral and transdermal HT appears to be safe with regard to CVD risk in women in menopausal transition and within the first years (e.g. 10 years) after menopause onset. In women with increased baseline thromboembolic risk, alternative non-hormonal medications are suggested as first-line treatment and transdermal estradiol alone or with micronized progesterone only should be considered when these options are not effective. When HT is initiated >10 years since the menopause onset (>60 years old), due to greater absolute risks of coronary heart disease, stroke and venous thromboembolism, HT should be used for the shortest time possible and in lowest possible dose and preferably transdermal administration should be recommended. However, an individualized treatment approach including baseline CVD risk assessment should be applied when prescribing HT. The majority of studies included in the current review are from North American and European populations, which might limit the generalizability of the findings of this review to the other populations. Finally, the quality of evidence included in this review was generally low or moderate, highlighting a need for more rigorous research to help us better understand HT and cardiovascular health.
journal_name
Hum Reprod Updatejournal_title
Human reproduction updateauthors
Oliver-Williams C,Glisic M,Shahzad S,Brown E,Pellegrino Baena C,Chadni M,Chowdhury R,Franco OH,Muka Tdoi
10.1093/humupd/dmy039subject
Has Abstractpub_date
2019-03-01 00:00:00pages
257-271issue
2eissn
1355-4786issn
1460-2369pii
5225102journal_volume
25pub_type
杂志文章abstract::Cryopreservation of testicular tissue might benefit prepubertal boys who must undergo chemotherapy or radiotherapy. Cryopreservation of testicular tissue and testicular cells for intracytoplasmic sperm injection (ICSI) is feasible and widely applied. Testicular tissue from prepubertal boys can also be frozen, by apply...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.4.378
更新日期:2001-07-01 00:00:00
abstract:BACKGROUND:Human long non-coding RNAs (lncRNAs) are an emerging category of transcripts with increasingly documented functional roles during development. LncRNAs and roles during human early embryo development have recently begun to be unravelled. OBJECTIVE AND RATIONALE:This review summarizes the most recent knowledg...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmw035
更新日期:2016-12-01 00:00:00
abstract:BACKGROUND:The cystic fibrosis transmembrane conductance regulator (CFTR) is a cAMP-activated Cl(-) and HCO(3)(-) conducting channel, mutations of which are known to be associated with male infertility. However, the underlying mechanisms remain elusive. METHODS:Literature databases were searched for papers on the topi...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dms027
更新日期:2012-11-01 00:00:00
abstract:BACKGROUND:The reproductive impact of adenomyosis and endometriosis is widely researched but the extent of these impacts remains elusive. It has been demonstrated that endometriosis, in particular, is known to result in subfertility but endometriosis and adenomyosis are increasingly linked to late pregnancy complicatio...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析
doi:10.1093/humupd/dmz012
更新日期:2019-09-11 00:00:00
abstract::The use of physical techniques such as scanning electron microscopy and microprobe analysis permits the analysis of valuable details of the structure of dried samples of mid-cycle cervical mucus during the period of maximum ferning. From a crystallographic point of view, particular attention was paid to the location, ...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/3.4.347
更新日期:1997-07-01 00:00:00
abstract:BACKGROUND:Estrogens are known to orchestrate reproductive events and to regulate the immune system during infections and following tissue damage. Recent findings suggest that, in the absence of any danger signal, estrogens trigger the physiological expansion and functional specialization of macrophages, which are immu...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/dmy026
更新日期:2018-11-01 00:00:00
abstract::Maternal use of marijuana, in which the exocannabinoid Delta(9)-tetrahydrocannabinol is the most active psychoactive ingredient, is known to have adverse effects on various aspects of reproduction including ovulation, spermatogenesis, implantation and pregnancy duration. Endogenous cannabinoids of which Anandamide is ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmm018
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:A dynamic balance between pro- and anti-inflammatory factors contributes to regulating human female reproduction. Chronic low-grade inflammation has been detected in several female reproductive conditions, from anovulation to embryo implantation failure. C-reactive protein (CRP) is a reliable marker of infla...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/dmaa012
更新日期:2020-09-01 00:00:00
abstract:UNLABELLED:BACKGROUND; Combined oral contraceptives (COCs) reduce levels of androgen, especially testosterone (T), by inhibiting ovarian and adrenal androgen synthesis and by increasing levels of sex hormone-binding globulin (SHBG). Although this suppressive effect has been investigated by numerous studies over many ye...
journal_title:Human reproduction update
pub_type: 杂志文章,meta分析,评审
doi:10.1093/humupd/dmt038
更新日期:2014-01-01 00:00:00
abstract::Single-dose and multiple-rising dose studies of recombinant follicle stimulating hormone (rFSH) in hypogonadotrophic male and female volunteers demonstrated that the rate of FSH absorption after i.m. injection is higher in men than in women. In the absence of endogenous FSH, a correlation between serum FSH and body we...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/2.2.153
更新日期:1996-03-01 00:00:00
abstract:BACKGROUND:Infertility affects ∼7% of all men. Despite much progress, mainly in genetics, its etiology remains obscure in ∼50% of cases. To fill this gap, imaging of the male genital tract (MGT) has progressively expanded, providing useful information in the assessment of MGT abnormalities. METHODS:A critical, systema...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmu042
更新日期:2015-01-01 00:00:00
abstract::Gestational surrogacy is a treatment option available to women with certain clearly defined medical problems, usually an absent uterus, to help them have their own genetic children. IVF allows the creation of embryos from the gametes of the commissioning couple and subsequent transfer of these embryos to the uterus of...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmg033
更新日期:2003-09-01 00:00:00
abstract::This review provides an overview of how women adjust emotionally to the various phases of IVF treatment in terms of anxiety, depression or general distress before, during and after different treatment cycles. A systematic scrutiny of the literature yielded 706 articles that paid attention to emotional aspects of IVF t...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dml040
更新日期:2007-01-01 00:00:00
abstract::Leiomyomata represent the most common gynaecological tumour in women of reproductive age, and are the primary indication for hysterectomy in the USA. Cytogenetic and genetic studies have, in recent years, advanced our understanding of the aetiology of these tumours. Cytogenetic aberrations involving chromosomes 6, 7, ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.1.8
更新日期:2001-01-01 00:00:00
abstract::The long-term clinical effects of ethinyl estradiol and the impact on environmental safety of the alkylated estrogen components used in combined contraceptive pills remain the subject of debate. The development of improved methods for the use of progestogen-only contraception would represent a viable and desirable opt...
journal_title:Human reproduction update
pub_type: 共识发展会议,杂志文章,评审
doi:10.1093/humupd/dmb025
更新日期:2003-07-01 00:00:00
abstract::Apoptosis is a selective process for deletion of cells in various biological systems. This event, similar to proliferation, is tightly regulated, with both processes playing essential roles in the homeostasis of renewable tissues. In human endometrium, proliferation and apoptosis occur at opposing poles of the menstru...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/1.4.303
更新日期:1995-07-01 00:00:00
abstract::Endometriosis is considered primarily a disease of the endometrial-subendometrial unit or archimetra. The clinical picture of endometriosis characterises this disease as a hyperactivation of genuine archimetrial functions such as proliferation, inflammatory defence and peristalsis. While the aetiology of the disease r...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.5.752
更新日期:1998-09-01 00:00:00
abstract::Amenorrhoea associated with reduced caloric intake and strenuous exercise leads to hypoestrogenism and is associated with clinical manifestations that include disordered eating, stress fractures, osteoporosis, and, as recently reported, a potential increase in the risk of premature cardiovascular disease. Disordered e...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh033
更新日期:2004-09-01 00:00:00
abstract:BACKGROUND:Overall, the incidence of male reproductive disorders has increased in recent decades. Testicular development during fetal life is crucial for subsequent male reproductive function. Non-genomic factors such as environmental chemicals, pharmaceuticals and lifestyle have been proposed to impact on human fetal ...
journal_title:Human reproduction update
pub_type: 杂志文章
doi:10.1093/humupd/dmz004
更新日期:2019-07-01 00:00:00
abstract::Androgen levels are measured in today's clinical practice almost exclusively by immunoassays. The androgen that is most frequently determined is testosterone (T), but sometimes also the levels of other testicular, ovarian and adrenal androgens such as 5alpha-dihydrotestosterone, androstenedione, dehydroepiandrosterone...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmm038
更新日期:2008-01-01 00:00:00
abstract::The placenta plays a key role in pregnancy, mediating exchanges between mother and fetus and maternal tolerance of fetopaternal antigens. In some species, it also produces hormones that ensure the maintenance of gestation and fetal well-being. This unique organ also has considerable potential for use as a model for va...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmg043
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:Hirsutism is the presence of excess body or facial terminal (coarse) hair growth in females in a male-like pattern, affects 5-15% of women, and is an important sign of underlying androgen excess. Different methods are available for the assessment of hair growth in women. METHODS:We conducted a literature se...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmp024
更新日期:2010-01-01 00:00:00
abstract::Nitric oxide (NO) is an important mediator of paracrine interactions, especially within the vascular system. It is a powerful inhibitor of platelet aggregation and a potent vasodilator. NO is also a neurotransmitter and it plays a role in cell-mediated cytotoxicity. NO-generating enzymes (nitric oxide synthases, NOS) ...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.5.565
更新日期:1998-09-01 00:00:00
abstract:BACKGROUND:The main objective of individualization of treatment in IVF is to offer every single woman the best treatment tailored to her own unique characteristics, thus maximizing the chances of pregnancy and eliminating the iatrogenic and avoidable risks resulting from ovarian stimulation. Personalization of treatmen...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmt037
更新日期:2014-01-01 00:00:00
abstract::Hormonal contraception has become more effective and more widely used, while the world population has grown from 3000 million in 1960 to 6000 million in 2000. There is a need for improved contraception, because legal abortion is used in a high proportion of pregnancies and illegal abortion continues to be common in so...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/8.4.359
更新日期:2002-07-01 00:00:00
abstract::Women suffer a higher incidence of osteoporosis than men, in part due to oestrogen deficiency after menopause. In fact, the administration of oestrogen to post-menopausal women is associated with a decrease of bone resorption. Tamoxifen is a widely used selective oestrogen receptor modulator in women with breast cance...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/6.3.255
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND:Endometriosis is recognized as a steroid-dependent disorder; however, the precise roles of nuclear receptors (NRs) in steroid responsiveness and other signaling pathways are not well understood. OBJECTIVE AND RATIONALE:Over the past several years, a number of paradigm-shifting breakthroughs have occurred in...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmz005
更新日期:2019-07-01 00:00:00
abstract::During the last decade oocyte donation has been highly successful for treating women previously thought to be hopelessly infertile. The pregnancy rate after oocyte donation is among the highest reported for any fertility-enhancing procedure. Most investigators have noted an increased rate of obstetric complications in...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/7.1.28
更新日期:2001-01-01 00:00:00
abstract::Operative hysteroscopy is a relatively new technique that has significantly improved the diagnosis and therapy of abnormal uterine bleeding. At first, the success of operative hysteroscopy in controlling this bleeding seemed extremely high but, with long-term follow-up, a significant failure rate became evident requir...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/4.4.350
更新日期:1998-07-01 00:00:00
abstract::The improved long-term survival of adolescents and young women treated for cancer has resulted in an increased focus on the effects of chemotherapy on ovarian function and its preservation. These women may seek advice and treatment regarding their reproductive status, including ways of preserving their fertility and p...
journal_title:Human reproduction update
pub_type: 杂志文章,评审
doi:10.1093/humupd/dmh052
更新日期:2005-01-01 00:00:00