Öz
Objective: to evaluate the effects of tibolon on serum lipoprotein (a) levels in patients with surgical menopause . Materials and methods: Forty-sixpremenopausal women (mean age 42 ± 5,1) undergoing surgical menopause were included in the study and transdermal estradiol was started 10 days after surgery. Serum lipids including lipoprotein(a) were measured before and after the surgery for 1 year with 3 month- intervals. Tibolone was added to the therapy in patients with serum concentration of lipoprotein (a) greater than 30 mg/dl. Results: Thirty-five women were still under follow-up at the end of 12 months. In 19 of them lipoprotein(a) levels increased despite transdermal estradiol. Lipoprotein (a) level before transdermal estradiol therapy was 17,7 ± 7. Serum lipo¬protein (a) levels at the 3rd month, 6th month, 9th and 12th month of transdermal estrogen therapy were 33,1 ± 29,4, 54,6 ± 28,4 (p
Anahtar Kelimeler
Lipoprotein(a) Estradiol Tibolone Androgen Antagonists Menopause
Kaynakça
- 1. Witteman J, Grobbe DE, Kok FJ, Hofman A, Valkenburg HA, Increased risk of atherosclerosis in women after the menopause. BMJ 1989; 298:642-5 2. Jackson G,Tibolone and the cardiovascular system. Eur Heart J Suppl 2001; 3: 16-21 3. Kannel WB, Hjortland MC, McNamara PM, Gordon T, Menopause and risk of cardiovascular disease. The Framingham Study. Ann Intern Med 1976; 85: 447-52 4. Kannel WB, Metabolic risk factors for coronary heart disease in women: perspective from the Framingham study. Am Heart J 1987; 114: 413-9 5. Mosca L, Manşon JE, Cardiovascular disease in women statement for healthcare profesionals from the American cardiovascular disease in women statement for healtcare professionals. American Heart Association Circulation. 1997; 96: 2468-82 6. Stampfer MJ, Estrojen replacement therapy and coronary heart disease a quantitative assesment of the epidemiologic evidence. Prev Med. 1991; 2047-63 7. Psaty BM, The risk of myocardial infartion associated with the combined use estrojen and progestin in postmenopausal women. Arch Inter Med 1994; 154: 1333-9 8. Grodstein F, Postmenopausal estrogen and progestin use and the risk of cardiovascular disease
- N Engl J Med 1996; 335:453-61 9. Writing Group for the Women's Healt Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healty Postmenopausal Women. JAMA 2002; 288:321-33 10. Morrisett JD, The role of Hpoprotein(a) in atherosclerosis.Curr Atheroscler Rep 2000; 2(3):243-50
- 11- Scanu A, Lipoprotein(a) heterogenety and biological relevance. J Clin Invest 1990, 85: 1709-1715 12-Uterman G, The mysteries of lipoprotein(a). Science 1989; 246:904-10 13. Wang S R, Changes in lipo(a) lipoprotein and lipid levels aftetr cessation of female sex hormone production and estrojen replacement therapy. Arch Intern Med 1996,156: 11 14. Brown SA, Plasma lipid lipoprotein kolesterol and apoprotein distribution in selected US communities the athersclerosis risk in communities study. Atheroscler Thromb Vase Biol 1993; 13: 1139-1158 15. Nabulsi AA, Association of hormone replacement therapy with varius cardiovacular risk factors in postmenopausal women. N Engl J.Med 1993; 15: 1069-75 16. Şendağ F, Karadadaş N., Effects of sequential combined transdermal and oral hormone replacement therapies on serum lipid and lipoproteins in postmenopausal women. Arch Gynecol Obstet 2002; 266:38-43 17. Meldrum DR, Biologic effects of transdermal estradiol. N Engl J Med 1986; 314:1615-20 18. Crook D, Comparison of transdermal and oral estrojen progestin replacement therapy effects of serum lipids and lipoproteins Am J Obstet Gynecol 1992; 166: 950-5 19. Speroff L, Internatonal consensus conference on postmenopausal hormone replacement therapy and the cardiovascular system. Fertil Steril 1994 ; 61: 592-5 20. Haenggi W, Reiesen W, Postmenopausal hormone replacement therapy with tibolone decerases serum lipoprotei(a). Eur J Clin Chem Clin Biochem 1993;31: 645-50 21. Rymer J, Crook. D, Effects of tibolone on serum concentrations of lipoprotein (a) in postmenopausal women. Acta Endocrinol 1993; 128(3): 259-62 22. Moliterno DJ, Jokınen E.V., MserezA.R., et all: No association between plazma lipoprotein (a) concentrations and precence or absence of coronary atherosclerosis in African Americans. Arterioscler Thromb Vase Biol 1995; 15: 850-85, 23. Haenggi W, Reiesen W, Postmenopausal hormone replacement therapy with tibolone decerases serum lipoprotein (a) Eur J Clin Chem Clin Biochem 1993,31: 645-650 24. Haeggi W., Lippuner K, Long term influence of diferent postmenopausal hormone replacement regimens on serum lipids and lipoprotein (a): a randomised study Br J Obstet Gynaecol. 1997; 7:108-117 25. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondery prevention of coronory heart disease in postmenopausal women. JAMA 1998; 280: 613
- 26. Chetkowski RJ Biological effects of transdermal estradiol. N Engl J Med 1986; 314: 1615-20 27. Grady D, Herrington D, Bittner V, ve ark. for the HERS Research Group. Cardiovasculer disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin DReplacement Study Follow-up (HERS II). JAMA 2002 ; 288: 49-57
- 28. İrican M, Sarandöl E, Uncu G, ve ark. Postmenopozal Kadınlarda Tibolon ve Transdermal Östrojen Kullanımının Lipid Düzeylerine ve Apolipoprotein B-İçeren Lipoproteinlerin Oksidasyonuna Etkisi. Jinekoloji ve Obstetrik Dergisi 1999; 13:202-207
- 29. Şan K, Api M, Unsal M, ve ark. Cerrahi Menopozda Kullanılan Konjuge Östrojen,Transdermal Östradiol ve Tibolonun Lipid Profili ve Kardiyovasküler Risk Üzerine Etkileri. Jinekoloji ve Obstetrik Dergisi 1999; 13: 30-35
Öz
Amaç: Cerrahi menopozdaki hastalarda 17-â-östradiol ve tibolonun serum lipoprotein (a) düzeyi üzerindeki etkilerini değerlendirmek Materyal melod: Çalışmaya benign nedenlerle yapılan histerektomi ve bilateral salpingo-ooferektomi sonrası cerrahi menopoza giren 46 .olgu alındı. Çalışmaya alman tüm olgularda operasyon öncesi lipoprotein (a) seviyeleri ölçüldü. Olgulara postoperatif 10. gün transdermal 17- K-östradiol tedavisi başlandı. Bundan sonra bir yıl süre ile her üç ayda bir olguların lipoprotein (a), seviyelerine bakıldı. Takip sırasında serum lipoprotein (a) seviyesi 30 mg/dl üzerine çıkan hastaların tedavilerine tibolon eklendi. Bulgular: Transdermal östradiol başlamadan önce lipoprotein (a) seviyeleri ortalama 17.7 ±7 olarak ölçülürken 3 ay transdermal östradiol teda¬visi sonrasında ölçülen lipprotein(a) seviyeleri 33,1 ±29,4, 6 ay sonraki lipoprotein (a) seviyesi 54,6±28,4, 9.ay serum lipoprotein (a) seviyesi 43,0 ±8,9, 12.ayda lipoprotein (a) seviyesi 29,5 ±2,5 olarak ölçüldü. Tedavi öncesine göre 3,6,9 ve 12. aylardaki serum lipoprotein (a) seviyelerindeki artış anlamlı bulundu(p
Anahtar Kelimeler
Lipoprotein(a) Östradiol Tibolon Androjen antagonistleri Menopoz
Kaynakça
- 1. Witteman J, Grobbe DE, Kok FJ, Hofman A, Valkenburg HA, Increased risk of atherosclerosis in women after the menopause. BMJ 1989; 298:642-5 2. Jackson G,Tibolone and the cardiovascular system. Eur Heart J Suppl 2001; 3: 16-21 3. Kannel WB, Hjortland MC, McNamara PM, Gordon T, Menopause and risk of cardiovascular disease. The Framingham Study. Ann Intern Med 1976; 85: 447-52 4. Kannel WB, Metabolic risk factors for coronary heart disease in women: perspective from the Framingham study. Am Heart J 1987; 114: 413-9 5. Mosca L, Manşon JE, Cardiovascular disease in women statement for healthcare profesionals from the American cardiovascular disease in women statement for healtcare professionals. American Heart Association Circulation. 1997; 96: 2468-82 6. Stampfer MJ, Estrojen replacement therapy and coronary heart disease a quantitative assesment of the epidemiologic evidence. Prev Med. 1991; 2047-63 7. Psaty BM, The risk of myocardial infartion associated with the combined use estrojen and progestin in postmenopausal women. Arch Inter Med 1994; 154: 1333-9 8. Grodstein F, Postmenopausal estrogen and progestin use and the risk of cardiovascular disease
- N Engl J Med 1996; 335:453-61 9. Writing Group for the Women's Healt Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Healty Postmenopausal Women. JAMA 2002; 288:321-33 10. Morrisett JD, The role of Hpoprotein(a) in atherosclerosis.Curr Atheroscler Rep 2000; 2(3):243-50
- 11- Scanu A, Lipoprotein(a) heterogenety and biological relevance. J Clin Invest 1990, 85: 1709-1715 12-Uterman G, The mysteries of lipoprotein(a). Science 1989; 246:904-10 13. Wang S R, Changes in lipo(a) lipoprotein and lipid levels aftetr cessation of female sex hormone production and estrojen replacement therapy. Arch Intern Med 1996,156: 11 14. Brown SA, Plasma lipid lipoprotein kolesterol and apoprotein distribution in selected US communities the athersclerosis risk in communities study. Atheroscler Thromb Vase Biol 1993; 13: 1139-1158 15. Nabulsi AA, Association of hormone replacement therapy with varius cardiovacular risk factors in postmenopausal women. N Engl J.Med 1993; 15: 1069-75 16. Şendağ F, Karadadaş N., Effects of sequential combined transdermal and oral hormone replacement therapies on serum lipid and lipoproteins in postmenopausal women. Arch Gynecol Obstet 2002; 266:38-43 17. Meldrum DR, Biologic effects of transdermal estradiol. N Engl J Med 1986; 314:1615-20 18. Crook D, Comparison of transdermal and oral estrojen progestin replacement therapy effects of serum lipids and lipoproteins Am J Obstet Gynecol 1992; 166: 950-5 19. Speroff L, Internatonal consensus conference on postmenopausal hormone replacement therapy and the cardiovascular system. Fertil Steril 1994 ; 61: 592-5 20. Haenggi W, Reiesen W, Postmenopausal hormone replacement therapy with tibolone decerases serum lipoprotei(a). Eur J Clin Chem Clin Biochem 1993;31: 645-50 21. Rymer J, Crook. D, Effects of tibolone on serum concentrations of lipoprotein (a) in postmenopausal women. Acta Endocrinol 1993; 128(3): 259-62 22. Moliterno DJ, Jokınen E.V., MserezA.R., et all: No association between plazma lipoprotein (a) concentrations and precence or absence of coronary atherosclerosis in African Americans. Arterioscler Thromb Vase Biol 1995; 15: 850-85, 23. Haenggi W, Reiesen W, Postmenopausal hormone replacement therapy with tibolone decerases serum lipoprotein (a) Eur J Clin Chem Clin Biochem 1993,31: 645-650 24. Haeggi W., Lippuner K, Long term influence of diferent postmenopausal hormone replacement regimens on serum lipids and lipoprotein (a): a randomised study Br J Obstet Gynaecol. 1997; 7:108-117 25. Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondery prevention of coronory heart disease in postmenopausal women. JAMA 1998; 280: 613
- 26. Chetkowski RJ Biological effects of transdermal estradiol. N Engl J Med 1986; 314: 1615-20 27. Grady D, Herrington D, Bittner V, ve ark. for the HERS Research Group. Cardiovasculer disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin DReplacement Study Follow-up (HERS II). JAMA 2002 ; 288: 49-57
- 28. İrican M, Sarandöl E, Uncu G, ve ark. Postmenopozal Kadınlarda Tibolon ve Transdermal Östrojen Kullanımının Lipid Düzeylerine ve Apolipoprotein B-İçeren Lipoproteinlerin Oksidasyonuna Etkisi. Jinekoloji ve Obstetrik Dergisi 1999; 13:202-207
- 29. Şan K, Api M, Unsal M, ve ark. Cerrahi Menopozda Kullanılan Konjuge Östrojen,Transdermal Östradiol ve Tibolonun Lipid Profili ve Kardiyovasküler Risk Üzerine Etkileri. Jinekoloji ve Obstetrik Dergisi 1999; 13: 30-35
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2004 |
| Yayımlandığı Sayı | Yıl 2004 Cilt: 35 Sayı: 3 |