Portada Simposios - Supplements - Haematologica

214 Haematologica (ed. esp.), volumen 85, supl. 2, octubre 2000
de LDL y aumento de HDL, y, fundamentalmente,
disminución de Lpa; b) efecto antiaterosclerótico; c)
mejora del metabolismo de la glucosa, y d) mejora
de las alteraciones del sistema hemostático debido
fundamentalmente a un aumento de la actividad fibrinolítica.
Otros efectos de la terapia hormonal
sustitutiva se ejercerían sobre la función vascular,
produciendo una vasodilatación y disminución de la
hiperplasia de la íntima.
Sin embargo, hay preguntas que quedan sin respuesta
ya que:
– Se precisan más estudios para delimitar con
exactitud el papel de la terapia hormonal sustitutiva
como prevención secundaria de la enfermedad cardiovascular
en relación con la vía de administración
y su efecto sobre la hemostasia en la mujer con enfermedad
coronaria preestablecida.
– Se tendría que delimitar si el aumento de riesgo
de tromboembolia venosa con la utilización de terapia
hormonal sustitutiva es en todas las mujeres o
sólo en aquellas con defectos genéticos que supongan
un aumento de riesgo, como factor V Leiden,
etc. Sin embargo, el efecto beneficioso sobre la enfermedad
cardiovascular en la mujer postmenopáusica
es mayor que el posible riesgo de trombosis venosa.
– Otro campo emergente es el empleo de otras terapias
como SERM (moduladores selectivos de los
receptores de estrógenos) 33,48 y su papel sobre la
enfermedad cardiovascular y la hemostasia.
En cualquier caso se precisan más estudios para
delimitar el papel beneficioso de la terapia hormonal
sustitutiva no sólo sobre la enfermedad cardiovascular
sino sobre otras patologías.
Bibliografía
1. Nabulsi AA, Folsom AR, White A et al. Association of hormone-replacement
therapy with various cardiovascular risk factors in postmenopausal
women. N Engl J Med 1993; 328: 1069.
2. Gensini GF, Micheli S, Prisco D et al. Menopause and risk of cardiovascular
disease. Thromb Res 1996; 84: 1.
3. The postmenopausal estrogen/progestin intervention. Effects of estrogen
or estrogen/progestin regimens on hearth disease risk factors in
postmenopausal women. JAMA 1995; 273: 199.
4. Grodstein F, Stampfer MJ, Manson JE et al. Postmenopausal estrogen
and progestin use and the risk of cardiovascular disease. N Engl J Med
1996; 335: 453.
5. Chae CV, Ridker PM, Manson JE. Postmenopausal hormone replacement
therapy and cardiovascular disease. Thromb Haemostas 1997;
78: 770.
6. Vaziri SM, Evans JC, Larson MG et al. The impact of female hormone
usage on the lipid profile: the Framingham Offspring Study. Arch Intern
Med 1993; 153: 2200.
7. Meade TW. Hormone replacement therapy and haemostatic function.
Thromb Haemostas 1997; 78: 765.
8. Hamsten A, Walldius G, Szamosi A et al. Plasminogen activator inhibitor
in plasma:risk factor for recurrent myocardial infarction. Lancet
1987; 2: 3.
9. Aznar J, Estellés A, Tormo G et al. Plasminogen activator inhibitor activity
and other fibrinolytic variables in patients with coronary artery disease.
Brit Heart J 1988; 59: 535.
10. Aznar J, Estellés A. Role of plasminogen activator inhibitor type 1 in the
pathogenesis of coronary artery disease. Haemostasis 1994; 24: 243.
11. Lee AJ, Lowe GOD, Smith WCS et al. Plasma fibrinogen in women:relationship
with oral contraception, the menopause and hormone replacement
therapy. Br J Haematol 1993; 83: 616.
12. Gilabert J, Estellés A, Cano A et al. The effect of estrogen replacement
therapy with or without progestogen on the fibrinolytic system and coagulation
inhibitors in postmenopausal status. Am J Obstet Gynecol
1995; 173: 1849.
13. Fröhlich M, Schunkert H, Hense H-W et al. Effects of hormone replacement
therapies on fibrinogen and plasma viscosity in postmenopausal
women. Br J Haematol 1998; 100: 577.
14. Kim CJ, Min YK, Ryu WS et al. Effect of hormone replacement therapy
on lipoprotein(a) and lipid levels in postmenopausal women. Influence
of various progestogen and duration of therapy. Arch Intern Med
1996; 156: 1693.
15. Hervio LH, Durlach V, Girard-Globa A et al. Multiple binding with identical
linkage: A mechanism that explain the effect of lipoprotein(a) on
fibrinolysis. Biochemistry 1995; 34: 13353.
16. Aznar J, Estellés A, Bretó M et al. Euglobulin clot lysis induced by tissue-type
plasminogen activator is reduced in subjects with increased
levels of lipoprotein(a). Thromb Res 1992; 66: 569.
17. Aznar J, Estellés A, Bretó M et al. Euglobulin clot lysis induced by tissue-type
plasminogen activator in subjects with increased levels and different
isoforms of lipoprotein(a). Thromb Res 1993; 72: 459.
18. Gilabert J, Estellés A. El sistema fibrinolítico en la anticoncepción oral
y en la terapéutica hormonal sustitutiva. Revisión y puesta al día. Prog
Obst Ginecol 1994; 37: 137.
19. Sullivan JM. Hormone replacement therapy and cardiovascular disease:
the human model. Br J Obstet Gynecol 1996; 103: (Supl. 13): 59.
20. Espeland MA, Marcovina SM, Miller V et al. Effects of postmenopausal
hormone therapy on lipoprotein(a) concentration. Circulation 1998;
98: 979.
21. Mijatovic V, van der Mooren MJ, Stehouwer CD et al. Postmenopausal
hormone replacement, risk estimators for coronary artery disease and
cardiovascular protection. Gynecol Endocrinol 1999; 13: 130.
22. Daly E, Vessey MP, Hawkins MM et al. Risk of venous thromboembolism
in users of hormone replacement therapy. Lancet 1996; 348: 981.
23. Grady D, Wenger NK, Herrington D et al. Postmenopausal hormone
therapy increases risk for venous thromboeembolic disease. The heart
and estrogen/progestin replacement study. Ann Intern Med 2000; 132:
689.
24. Lowe G, Woodward M, Vessey M et al. Thrombotic variables and risk of
idiopathic venous thromboembolism in women aged 45-64 years. Relationship
to hormone replacement therapy. Thromb Haemostas 2000;
83: 530.
25. Teede HJ, McGrath BP, Smolich JJ et al. Postmenopausal hormone replacement
therapy increases coagulation activity and fibrinolysis. Arterioscler
Thromb Vasc Biol 2000; 20: 1404.
26. Van Baal WM, Emeis JJ, van der Mooren et al. Impaired procoagulant-anticoagulant
balance during hormone replacement therapy A
randomised, placebo-controlled 12-week study. Thromb Haemostas
2000; 83: 29.
27. Gebara OCE, Mittleman MA, Sutherland P et al. Association between
increased estrogen status and increased fibrinolytic potential in the Framingham
offsprimg study. Circulation 1995; 91: 1952.
28. Shahar E, Folsom AR, Salomaa VV et al. Relation of hormone-replacement
therapy to measures of plasma fibrinolytic activity. Circulation
1996; 93: 1970.
29. Kon Koh K, Horne MK, Cannon R. Effects of hormone replacement
therapy on coagulation, fibrinolysis, and thrombosis risk in postmenopausal
women. Thromb Haemostas 1999; 82: 626.
30. Scarabin PY, Alhencgelas M, Plubureau G et al. Effects of oral and
transdermal estrogen/progesterone regimens on blood coagulation
and fibrinolysis in postmenopausal women. A randomized controlled
trial. Arterioscler Thromb Vasc Biol 1997; 17: 3071.
31. Mijatovic V, Kenemans P, Van der Mooren MJ et al. Postmenopausal
oestradiol-dydrogesterone therapy favourably affects fibrinolysis and
Lp(a) in healthy women. Fibrinol Proteol 1999;13: 177.
32. De Valk de Roo GW, Stehouwer C, Meijer P et al. Both raloxifene and
estrogen reduce major cardiovascular risk factor in healthy postmenopausal
women. A 2-year, placebo-controlled study. Arterioscler Thromb
Vasc Biol 1999; 19: 2993.
33. Estellés A, Cano A, Falcó C et al. Lipoprotein(a) levels and isoforms and
fibrinolytic activity in postmenopause. Influence of hormone replacement
therapy. Thromb Haemostas 1999; 81: 104.
34. Sullivan JM, El-Zeky F, Vander Zwaag R et al. Effect on survival of estrogen
replacement therapy after coronary artery bypass grafting. Am J
Cardiol 1997; 79: 847.
35. Keefe JH, Kim SC, Hall RR et al. Estrogen replacement therapy after
coronary angioplasty in women. J Am Coll Cardiol 1997; 29: 1.
36. O’Brien JE, Peterson ED, Keeler GP. Relation between estrogen replacement
therapy and restenosis after percutaneous coronary interventions.
J Am Coll Cardiol 1997; 28: 1111.
37. Hulley S, Grady D, Bush T et al. Randomized trial of estrogen plus progestin
for secondary prevention of coronary heart disease in postmenopausal
women. JAMA 1998; 280: 605.
38. Estellés A, Tormo G, Aznar J et al. Reduced fibrinolytic activity in coronary
heart disease in basal conditions and after exercise. Thromb Res
1985; 40: 373.
39. Páramo J A, Colucci M, Collen D. Plasminogen activator inhibitor in the
blood of patients with coronary artery disease. Br Med J 1985; 291:
573.
40. Hamsten A, Wiman B, De Faire U et al. Increased plasma levels of a rapid
inhibitor of tissue plasminogen activator in young survivors of myocardial
infraction. N Engl J Med 1985; 313: 1557.
41. Schneiderman J, Sawdey M S, Keeton M RG et al. Increased type I plasminogen
activator inhibitor gene expression in atherosclerotic human
arteries. Proc Natl Acad Sci USA 1992; 89: 6998.