Menopausia y fisiopatología del riesgo cardiovascular.

[Menopausia y fisiopatología del riesgo cardiovascular.]

DV Awad1, JL Neyro2

1. Consejo de la Facultad de Medicina. Pontificia Universidad Javeriana. Academia Nacional de Medicina de Colombia. Bogotá DC, Colombia.; 2. Servicio de Ginecología y Obstetricia. Facultad de Medicina y Odontología. Universidad del País Vasco. EHU-UPV. Hospital Universitario Cruces. Baracaldo. España.

Publicado: 2018-12-30

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Resumen

RESUMEN.
La menopausia supone el cese de la actividad de los ovarios y con él la disminución drástica en la producción estrogénica. El déficit de estrógenos, presente desde la perimenopausia, tiene una influencia negativa en el endotelio vascular y produce disfunción del endotelio vascular que es el origen de la arteriosclerosis y de la enfermedad cardiovascular en última instancia.El análisis de los factores de riesgo cardiovascular puede dar luz sobre el incremento de la enfermedad cardiovascular que la evidencia científica señala como origen de enfermedad en la perimenopausia y periodos posteriores de la vida de la mujer. Durante la postmenopausia la disminución del efecto estrogénico conlleva a la resistencia periférica a la insulina, obesidad central (abdominal) y dislipemia y a otros factores de riesgo de enfermedad cardiaca y vascular.

Revisar los factores de riesgo cardiovascular durante el climaterio puede dar valor a la pesquisa de los mismos en la asistencia sanitaria diaria a mujeres durante su transición menopáusica. Este debe ser un objetivo prioritario de la asistencia ginecológica al climaterio.

ABSTRACT.
Menopause causes the cessation of the activity of the ovaries and with it the drastic decrease in estrogenic production. Estrogen deficiency, present from perimenopause, has a negative influence on the vascular endothelium and produces vascular endothelial dysfunction that is the origin of arteriosclerosis and ultimately cardiovascular disease.The analysis of cardiovascular risk factors can shed light on the increase in cardiovascular disease that the best scientific evidence reports as the origin of disease in perimenopause and later periods of a woman's life. During postmenopause, the decrease in the estrogenic effect leads to peripheral resistance to insulin, central obesity (abdominal) and dyslipidemia, and to other risk factors for heart and vascular disease.

Reviewing the cardiovascular risk factors during the climacteric can highlight the screening of them in the daily sanitary assistance to women during their menopausal transition. This should be a priority objective of gynecological assistance to the climacteric state.


Abstract

RESUMEN.
La menopausia supone el cese de la actividad de los ovarios y con él la disminución drástica en la producción estrogénica. El déficit de estrógenos, presente desde la perimenopausia, tiene una influencia negativa en el endotelio vascular y produce disfunción del endotelio vascular que es el origen de la arteriosclerosis y de la enfermedad cardiovascular en última instancia.El análisis de los factores de riesgo cardiovascular puede dar luz sobre el incremento de la enfermedad cardiovascular que la evidencia científica señala como origen de enfermedad en la perimenopausia y periodos posteriores de la vida de la mujer. Durante la postmenopausia la disminución del efecto estrogénico conlleva a la resistencia periférica a la insulina, obesidad central (abdominal) y dislipemia y a otros factores de riesgo de enfermedad cardiaca y vascular.

Revisar los factores de riesgo cardiovascular durante el climaterio puede dar valor a la pesquisa de los mismos en la asistencia sanitaria diaria a mujeres durante su transición menopáusica. Este debe ser un objetivo prioritario de la asistencia ginecológica al climaterio.

ABSTRACT.
Menopause causes the cessation of the activity of the ovaries and with it the drastic decrease in estrogenic production. Estrogen deficiency, present from perimenopause, has a negative influence on the vascular endothelium and produces vascular endothelial dysfunction that is the origin of arteriosclerosis and ultimately cardiovascular disease.The analysis of cardiovascular risk factors can shed light on the increase in cardiovascular disease that the best scientific evidence reports as the origin of disease in perimenopause and later periods of a woman's life. During postmenopause, the decrease in the estrogenic effect leads to peripheral resistance to insulin, central obesity (abdominal) and dyslipidemia, and to other risk factors for heart and vascular disease.

Reviewing the cardiovascular risk factors during the climacteric can highlight the screening of them in the daily sanitary assistance to women during their menopausal transition. This should be a priority objective of gynecological assistance to the climacteric state.

Citas

[1] BIBLIOGRAFÍA.

[2] En www.who.int/topics/risk_factors/es.

[3] Almeida N, Castiel LD, Ayres JR. Riesgo: concepto básico de la epidemiología. Salud colectiva, Buenos Aires, septiembre-diciembre 2009; 5(3):323-344.

[4] Alegría E, Alegría A, Alegría E. Estratificación del riesgo cardiovascular: importancia y aplicaciones. Rev Esp Cardiol Supl. 2012; 12(C): 8-11

[5] Wilson PW, D’Agostino RB, Levy D, et al. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97: 1837-47.

[6] Conroy RM, Pyörälä K, Fitzgerald AP, et al, SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003; 24: 987-1003.

[7] Banco Mundial. Esperanza de vida al nacer, mujeres (años) En http://datos.bancomundial.org/indicador/SP.DYN.LE00.FE.IN/countries/

[8] World Health Organization (WHO). World Health Statistics 2014. http://www.who.int/gho/publications/world_health_statistics/2014/en/

[9] Organización Mundial de la Salud. Centro de prensa. Nota descriptiva: Enfermedades Cardiovasculares. Boletín 2014. En http://www.who.int/es/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)

[10] Espinoza MT. Impacto de la menopausia y manifestaciones clínicas - sistema cardiovascular. En “Menopausia, una visión clínica”. Vásquez-Awad D, Palacios S. ISBN 978-958-46-8943-6. Ed. Kimpres, Bogotá DC, 2016.

[11] Menopausia, terapia de reemplazo hormonal y riesgo cardiovascular. Vásquez-Awad D. In press.

[12] Collins P, Webba CM, de Villiers T, et al. Cardiovascular risk assessment in women – an update. Climacteric 2016;19: 329–36.

[13] Rexrode KM, Manson JE, Lee IM, et al. Sex hormone levels and risk of cardiovascular events in postmenopausal women. Circulation. 2003; 108 (14):1688.

[14] Kannel WB. Metabolic risk factors for coronary heart disease in women: perspective from the Framingham Study. Am Heart J 1987;114: 413–19 18. Kannel WB, Wilson PW.

[15] Huxley R, Barzi F, Woodward M. Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ. 2006; 332(7533):73

[16] Zuanetti G, Latini R, Maggioni AP, et al. Influence of diabetes on mortality in acute myocardial infarction: data from the GISSI-2 study. J Am Coll Cardiol. 1993; 22(7):1788.

[17] Colditz GA, Willet WC, Stampfer MJ, et al. Menopause and the risk of coronary heart disease in women. N Engl J Med. 1987; 316 (18):1105.

[18] Barret-Connor E, Busch TL. Estrogens and coronary heart disease in women. J Am Med Ass 1991. 265(14):186118.

[19] Baer HJ1, Glynn RJ, Hu FB, et al. Risk factors for mortality in the nurses' health study: a competing risks analysis. Am J Epidemiol. 2011 Feb 1; 173 (3):319-29.

[20] Fax CS, Massaro JM, Hoffmann U, et al. Abdominal visceral and subcutaneous adipose tissue compartments: association with metabolic risk factors in the Framingham Heart Study. Circulation. 2007; 116:39-48.

[21] Lemieux S, Prud’homme D, Bouchard C, et al. Sex differences in the relation of visceral adipose tissue accumulationto total body fatness. Am J Clin Nutr. 1993; 58:453-7.

[22] Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: a guideline from the American heart association. Circulation 2011; 123 (11)1243.

[23] Folsom AL, French SA, Zheng W, et al. Weight Variability and mortality: the Iowa Women’s Health Study. Int J Obes Relat Metab Disort 1996; 20 (8):704.

[24] Alberty KG; Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interin statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerotic Society and International Association for the Study of Obesity. Circulation. 2009. 120; 1540-5.

[25] Ninomiya JK, L’ltalien G, Criqui MH, et al. Association of the metabolic syndrome with history of myocardial infarction and stroke in the Third National Health and Nutrition Examination Survey. Circulation. 2004; 109 (1);42.

[26] Williet WC, Green A, Stampfer MJ, et al Relative and absolute excess risks of coronary heart disease among women who smoke cigarettes. N Engl J Med. 1987; 317 (21):1303.

[27] Rosenberg L, Palmer JR, Shapiro S. Decline in the risk of myocardial infarction among women who stop smoking. N Engl J Med. 1990; 322 (4):213.

[28] National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002; 39 (2 Suppl 1):S1.

[29] Manjunath G, Tighiouart H, Ibrahim H, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community. J Am Coll Cardiol. 2003 Jan 1; 41 (1):47-55.

[30] Fuchs CS, Stampfer MJ, Colditz GA, et al. Alcohol consumption and mortality among women N Engl J Med. 1995; 332 (19):1245.

[31] Dessapt AL, Gourdy P. Menopause and cardiovascular risk. J Gynecol Obstet Biol Reprod. 2012; 41 (7):13-9.

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