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1、EstrogenReplacementTherapyandthePreventionofCoronaryHeartDiseaseinWomen:FriendorFoe?DavidParra,Pharm.D.,BCPSClinicalPharmacySpecialistDepartmentofCardiologyVeteransAffairsMedicalCenterWestPalmBeach,FLObjectivesUnderstandthemagnitudeofcoronaryheartdisease(CHD)inpostmenopausalwomenEx
2、plainthemechanismsbehindestrogen’sproposedcardioprotectiveeffectReviewtheobservationaldatasupportingtheuseofestrogeninpreventingCHDDiscusstheresultsoftherecentlycompletedHeartandEstrogen/progestinReplacementStudy(HERS)andapplythemtoclinicalpracticeCardiovascularDiseaseinWomenOneint
3、wowomenwilldieofcardiovasculardisease(CVD)ifallformsofmajorCVDwereeliminatedlifeexpectancywouldincreaseby10yearsOnein26womenwilldieofbreastcancerifallformsofcancerwereeliminatedlifeexpectancywouldincreaseby3years1998HeartandStrokeStatisticalUpdate,AHA.63%ofwomen(48%ofmen)diesuddenl
4、yfromcoronaryheartdisease44%ofwomen(27%ofmen)willdiewithinoneyearafteraheartattackCardiovascularDiseaseinWomen1998HeartandStrokeStatisticalUpdate,AHA.505,44033,130256,84448,96145,1360100200300400500600TotalCVCancerCOPDPneumoniaFluDiabetesDeathsinthousandsLeadingCausesofDeathforAllF
5、emalesUnitedStates1995MortalityDataAdaptedfrom1998HeartandStrokeStatisticalUpdate,AHA.50%CoronaryHeartDisease1%CongenitalHeartDefects1%RheumaticFever/ RheumaticHeartDisease4%CongestiveHeartFailure2%Atherosclerosis4%HighBloodPressure22%OtherCoronaryHeartDisease: DespiteAdvances,Stil
6、lthe#1KillerPercentageBreakdownofDeathsFromCardiovascularDiseasesUnitedStates:1995Mortality,FinalData16%StrokeAmericanHeartAssociation1998HeartandStrokeFacts:StatisticalUpdate4204404604805005207980818283848586878889909192939495YearsDeathsinThousandsMalesFemalesCardiovascularDisease
7、MortalityTrendsUnitedStates1995MortalityDataAdaptedfrom1998HeartandStrokeStatisticalUpdate,AHA.PremenopausalPostmenopausalDecreaseinHDLIncreaseinLDL,triglycerides,apolipoproteinsBandA-IIncreaseindiastolicbloodpressureMenopauseexertsanegativeeffectonCHDriskIncidenceofCoronaryHeartDi
8、sease0246810121416Annualra
