arthyperАртериальная гипертензия"Arterial’naya Gipertenziya" ("Arterial Hypertension")1607-419X2411-8524Antihypertensive League10.18705/1607-419X-2022-28-4-357-375arthyper-2233Research ArticleСтатьиArticlesВозможности применения менопаузальной гормональной терапии у женщин высокого сердечно-сосудистого рискаThe use of menopausal hormone therapy in women at high cardiovascular riskhttps://orcid.org/0000-0002-1788-4282МироноваС. В.MironovaS. V.

Миронова Снежана Владимировна — кандидат медицинских наук, ассистент кафедры пропедевтики внутренних болезней № 2 Пермский ГМУ им. акад. Е.А. Вагнера.

Пермь.

Snezhana V. Mironova - MD, PhD, Assistant, Department of Propaedeutics of Internal Diseases No. 2, Perm State Medical University named after Academician E.A. Wagner.

Perm.

sv.mironova.2017@yandex.ruhttps://orcid.org/0000-0001-7003-5186КозиоловаН. А.KoziolovaN. A.

Козиолова Наталья Андреевна — доктор медицинских наук, профессор, заведующая кафедрой пропедевтики внутренних болезней № 2 ВПО Пермский ГМУ им. акад. Е.А. Вагнера.

ул. Петропавловская, д. 26, Пермь, 614000.

Natalya A. Koziolova - MD, PhD, DSc, Professor, Head, Department of Propaedeutics of Internal Diseases No. 2, Perm State Medical University named after Academician E.A. Wagner.

26 Petropavlovskaya street, Perm, 614000.

nakoziolova@mail.ruПермский государственный медицинский университет имени академика Е.А. Вагнера Министерства здравоохранения Российской ФедерацииРоссияPerm State Medical University named after Academician E.A. WagnerRussian Federation202218072022284357375Copyright © Миронова С.В., Козиолова Н.А., 20222022Миронова С.В., Козиолова Н.А.Mironova S.V., Koziolova N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://htn.almazovcentre.ru/jour/article/view/2233

В обзорной статье представлены этапы применения менопаузальной гормональной терапии (МГТ) с позиций первичной и вторичной профилактики риска развития ишемической болезни сердца (ИБС) и смертельных исходов. На основании полученных данных был обновлен ряд рекомендаций и согласительных документов, отражающих необходимость соблюдения «временной гипотезы» при назначении МГТ в целях улучшения прогноза. Показаны аргументы возможного применения МГТ как в первичной профилактике сердечно-сосудистых заболеваний у женщин с кардиоваскулярными факторами риска, так и у пациенток с ИБС в анамнезе, перенесенными инфарктами миокарда, при развитии хронической сердечной недостаточности и фибрилляции предсердий. В 2021 году было выдвинуто предложение определять выбор МГТ в зависимости от групп сердечно-сосудистого риска (ССР). Однако такой подход к выбору МГТ исключает персонификацию и индивидуализацию возможности применения данного метода лечения при наличии отдельных факторов низкого, промежуточного ССР, таких как АГ, гиперхолестеринемия, сахарный диабет 2-го типа и других, особенно при их хорошем контроле. Поэтому принятие клинических решений о применении МГТ в условиях высокого ССР и наличии индивидуальных клинически значимых факторов риска должно осуществляться мультидисциплинарной командой, что позволит исключить как немотивированные запреты, так и назначения при наличии противопоказаний.

The review article presents the stages of the use of menopausal hormone therapy (MHT) from the standpoint of primary and secondary prevention of the risk of developing coronary heart disease (CHD) and deaths. Based on the data obtained, a number of guidelines and statement documents have been updated to reflect the need to comply with the “time hypothesis” in the appointment of MHT in order to improve the prognosis. The arguments of the possible use of MHT are shown both in the primary prevention of cardiovascular diseases in women with cardiovascular risk factors, and in patients with a history of coronary artery disease, myocardial infarctions, with the development of chronic heart failure and atrial fibrillation. In 2021, a proposal was put forward to determine the choice of MHT depending on the cardiovascular risk groups (CVR). However, such an approach to the choice of MHT excludes the personification and individualization of the possibility of using this method of treatment in the presence of certain factors of low, intermediate CVR, such as arterial hypertension, hypercholesterolemia, type 2 diabetes mellitus and others, especially with their good control. Therefore, the adoption of clinical decisions on the use of MHT in conditions of high CVR and the presence of individual clinically significant risk factors should be carried out by a multidisciplinary team, which will exclude both unmotivated prohibitions and appointments in the presence of contraindications.

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The authors declare that there are no conflicts of interest present.