Department of Obstetrics and Gynecology County Teaching Hospital and Institute of Clinical and Nurse Sciences, University of Pécs, Faculty of Health Sciences, H-7623 Pécs, Rákóczi u.2., Hungary
1 To whom correspondence should be addressed. E-mail: bodisj@freemail.hu
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Abstract |
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Key words: cardiovascular disease/haematocrit/HRT/menopause
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Introduction |
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Cardiovascular diseases and HRT |
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However, the Framingham Study (Eaker et al., 1987), a notable exception, demonstrated an adverse or no effect of estrogen treatment, depending on how CVD was defined and which multiple-regression model was used. This suggests that estrogens may not be the only factor protecting the premenopausal women against CVD.
The article of Tunstall-Pedoe demonstrates a delayed rise in coronary deaths in women compared with men (Tunstall-Pedoe, 1998). Also, it shows that the absolute difference in risk of CHD between men and women continues to increase with age and never closes. The author of that article emphasizes that there is no rebound acceleration in CHD in women at, and after, the menopause. However, data from the same article show that the number of coronary deaths follows the same curve in women as that of men but shifted to higher values of age by about 10 years. It is easy to see that the development of conditions ending up in death from CHD is a process unfolding for many years until it causes clinically significant damage to the cardiovascular system. In fact, statistics demonstrating a delayed rise clearly reflect the fact that the cardiovascular system is exhausted earlier in men than in women, so the 3035-year reproductive period has a protracted beneficial effect on the cardiovascular status for about 1015 more years. In our opinion, the widening gap of absolute difference in risk of CHD between the two sexes also demonstrates that the lack of a comparable 30 year female type reproductive period in the male has a long term negative effect on the cardiovascular system. We also believe that the appropriate evaluation of any relationship between HRT and death rates from CHD is to be analysed by comparing HRT-user and non-user post-menopausal women instead of comparing the two sexes.
Cardiovascular diseases and haemorheology
The Stockholm Study (Bottiger et al., 1973) of risk factors for myocardial infarction showed that in subjects aged <60 years, those with a haemoglobin in the top quintile had twice the incidence of new coronary events compared with the remaining 80%. More recently in the Puerto Rico Study (Sorlie et al., 1981
) of 8700 men followed for 8 years, clinical evidence of myocardial ischaemia was more than double in the high haematocrit (>0.49) than low haematocrit group (<0.42). A similar result was found in a study of 8000 Japanese men followed for 10 years (Carter et al., 1983
). A six-fold increase in mortality was also recorded by Burge et al. (1975
) in patients with a haematocrit of >0.50. Clinical evidence suggests that a high packed red cell volume may be a primary risk factor in cardiovascular diseases. The threshold level for potentially hazardous haematocrit is around 0.50. The ratio of the incidence of cardiovascular complications for haematocrit values above and below this level is approximately 2:1. Most groups believed to have relatively low risk of cardiovascular disease, such as pre-menopausal women, vegetarians and sportsmen, also exhibit a relatively low haematocrit value and possibly other favourable haemorheological properties. To recognize that a relatively higher haematocrit could be dangerous and should draw medical attention, we should accept that the normal range of a physiological variable does not necessarily correspond to the optimal one. Haemorheological abnormalities have been found in patients with acute myocardial infarction (Jan et al., 1975
; Di Perri et al., 1979
). Analysis of the various haemorheological components showed that there were significant increases of haematocrit, plasma viscosity and red cell aggregation in acute myocardial infarction, as compared with the normal control.
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Reproductive age, menopause and haemorheology |
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Conclusions |
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We are confident, that, within this wide range strategy, hormone replacement should receive its proper place, and this opinion could be further supported by results of multicentre studies focusing on the detailed issue.
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Acknowledgement |
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References |
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