Благодаря успехам современной медицины, в связи со снижением рождаемости и увеличением продолжи-тельности жизни в XXI веке население экономически вы-сокоразвитых стран стареет. Среди болезней старения и причин смертности у женщин доминируют сердечно-со-судистые заболевания (ССЗ) и их осложнения. Многочис-ленные исследования посвящены изучению одной из важнейших возрастных проблем -изменению с возрас-том эластических свойств сосудов, нарастанию жесткости крупных артериальных стволов, что рассматривается как один из маркеров сосудистого старения. Биомеханиче-ские свойства сосудов, в частности показатель упруговяз-кого состояния артерий, скорость распространения пуль-совой волны (СРПВ) рассматриваются в качестве одного из критериев биологического возраста, поскольку, демон-стрируя тесную зависимость с хронологическим возрас-том в совокупности с другими критериями, описывают замедленный либо ускоренный тип старения человека. Представлены существующие в настоящее время теории старения: эволюционная теория о генетически запрограмми-рованном старении, свободнорадикальная, митохондриальная, теломерная, элевационная, иммунологическая теории, гипотеза о существовании генетической программы самоуничтожения. Рассмотрены особенности сосудистого старения, развития заболеваний сердечно-сосудистой системы у женщин от менархе до менопаузы. Подчеркнуто, что ригидность стенки артерий напрямую связана со скоростью распространения пульсовой волны, определение которой является «золо-тым стандартом» измерения этой ригидности и может быть использовано как фактор прогноза смерти от сердечно-сосу-дистых заболеваний.Авторы информируют об отсутствии конфликта интересов. Ключевые слова: теории старения, риск развития сердечно-сосудистых заболеваний, жесткость сосудистой стенки, менопаузальная гормональная терапия, климактерический синдром, скорость распространения пульсовой волны.The review presents currently existing aging theories, such as an evolutionary theory of genetically programmed aging; freeradical, mitochondrial, telomere, elevation, and immunological theories; and a hypothesis for a genetic self-destruction program. It considers the specific features of vascular aging, the development of cardiovascular diseases in women from menarche to menopause. Arterial wall stiffness is emphasized to be directly related to the propagation velocity of a pulse wave, the determination of which is the gold-standard measure of this stiffness and may be used as a factor for prediction of cardiovascular death. The authors declare no conflicts of interest.
The article tells about the incidence and severity of menopausal symptoms in women during pre-, peri- and post-menopausal periods as well as the rationale for their treatment. It was found that the use of menopausal hormone therapy (MHT) should be individualized and should not be cancelled solely due to the woman's age. The results of numerous studies of women in the transition from pre- to peri- and further to postmenopause are demonstrated. Limitations in the duration of MHT therapy are considered, and the need to develop safer therapies for long-term treatment of hot flushes is substantiated. It is proved that ultra-low-dose medication is effective for the treatment of both moderate and severe vasomotor symptoms.
The article presents the results of recent studies on the effectiveness, safety and duration of menopausal hormone therapy (MHT). The main cardio-metabolic risk factors for cardiovascular diseases are formed in women precisely during the transition to menopause and are clearly associated with the appearance of vegetative menopausal symptoms and the development of endothelial dysfunction, which is a predictor of future serious health problems, especially cardiovascular diseases. The results of a number of epidemiological studies have shown that in women with severe climacteric manifestations, especially with hot flashes, the overall risk of developing cardiovascular diseases is increased. The need for early initiation of MHT is an indisputable truth and is not disputed by anyone, but the formed tendency to discontinue treatment in 56 years raises many questions among patients and their doctors. However, recent guidelines from the International Menopause Society state that there is no reason to arbitrarily limit the duration of MHT. This paper presents current evidence on the indications and benefits of low and ultra-low doses of MHT. In view of the high efficacy and safety of low doses of MHT, they seem to be the most acceptable starting doses of oral MHT for most women. In addition, women with early menopause should also receive higher doses of estrogens, as they are more physiological for them. The choice in favor of starting MHT in a postmenopausal woman with a low or ultra-low dose in each case should be selected individually.
The article presents the results of studying the effect of red clover extract (Feminal®) pulse wave velocity in women with menopausal syndrome periand postmenopause. The results obtained allow us to conclude that therapy with red clover extract is effective for treating moderately severe COP, and has a significant effect on the speed of the pulse wave.
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